AW: [HSF] anomalous RCA

[Tea Acuff]

I would think that with a good CTA and a good read one whould likely be able tell if the artery intramural, which is the indication for "unruffing". Interestingly one of my colleagues did an anomalous LM off the RCA passing between the PA and aorta today. He bypassed them and had to divide the PA to get to an area of the circ large enough to bypass.
tea


----- Original Message ----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, February 7, 2007 1:23:33 AM
Subject: AW: [HSF] anomalous RCA


Hal,
if you get a 64 slice CT, please send a picture of the artery.
Good luck
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Ramaiah,
Chandrashekar
Gesendet: Dienstag, 6. Februar 2007 13:43
An: OpenHeart-L at lists.hsforum.com
Betreff: RE: [HSF] anomalous RCA

Hal,
I did a bit of literature search and found an article in JACC with 242
patients
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pub
med&cmd=Retrieve&dopt=abstractplus&list_uids=1512344)

Now I stand corrected... they recommend fixing them (46% were RCA). But
again you should look at the Ct/Coronary angio and see if it is a good
sized RCA that could cause sudden death.

Let us know what you did and how it went.
Chand




-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of
msekela at aol.com
Sent: Monday, February 05, 2007 11:34 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] anomolous RCA

Hal,
     I've done 3 of these cases over the last 5 years and had to do one
over. I initially had some hesitancy in mobilizing the RCA. It hasn't
been that difficult. The artery usually courses to the left of the
aorta, between the PA and the Aorta and can easily be seen in that area.
Using sharp tenotomy scissors whiled clamped you can mobilize enough of
the vessel to re attach it to the aorta anteriorly and ligate the
segment going to the coronary os on the aorta. There is plenty of
additional length as the vessel has to course clear around the aorta. In
those that I've done no large branches needed ligation. The vessel is
delicate.
     The one I did over I bypassed with the IMA. Initially had good
relief of symptoms. When they recurred the RIMA had a string sign. The
RCA was a huge vessel. The redo on that case taught me how to moblize
and reattach the vessel.
                           Mike 


-----Original Message-----
From: hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 5 Feb 2007 3:24 PM
Subject: [HSF] anomolous RCA


Dear Members,
  I was recently referred a case of a man with an anomolous takeoff of
the RCA.  
It originates from the left main and courses between the aorta and the
PA.  My 
plan is to graft the RCA with a RIMA.  Do I need to occlude the RCA
between the 
aorta and PA so as to eliminate competitive flow?
Hal
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