Journal of Pediatric Cardiology and Cardiac Surgery

Anomalous aortic origin of the right coronary artery (AAORCA) is a rare congenital anomaly. It is even rarer in the elderly, and there is ongoing controversy regarding techniques for surgical intervention. We describe a case of AAORCA that was successfully treated using a reimplantation technique. A 65-year-old female with a history of exercise-related angina was referred to our hospital. Enhanced computed tomography (CT) revealed AAORCA. Ischemia was detected on electrocardiogram exercise testing, although myocardial perfusion scintigraphy had failed to show it; thus, surgical intervention was recommended. We applied a reimplantation technique, because the right coronary artery (RCA) was not hypoplastic but its proximal course was interarterial with a slit-like ostium. We transected the RCA beyond the intramural portion and closed the residual stump proximally. An aortic wall was punched out higher in the right facing sinus of Valsalva to create a neo-ostium. The RCA was spatulated on the inferior side and anastomosed to the neo-ostium. The patient’s postoperative course was uneventful. Postoperative enhanced CT showed neither stenosis nor kinking of the reimplanted vessel. The patient has been asymptomatic for more than 2 years since the operation. The reimplantation technique was useful for AAORCA with a slit-like ostium and an interarterial course. Its medium- to long-term outcomes are reported to be satisfactory. Therefore, the reimplantation technique could easily be applied to similar cases.