Anomalous origin of the right coronary artery with aortopulmonary window: functional and surgical considerations.

Abstract

A rare case of anomalous origin of the right coronary artery from the pulmonary artery associated with a large aortopulmonary window in a 4-month-old boy is reported. The right coronary artery is exposed to systemic pressure and carries fairly well-oxygenated blood to the myocardium. Angiographic diagnosis could be difficult because of the simultaneous filling of both great arteries which obscures the origin of the anomalous vessel. Closure of the aortopulmonary window alone could result in acute myocardial ischaemia. A plastic procedure for correction of this association of defects, which should allow normal growth, is described.

Congenital Anomalies and Malformations of the Vasculature

“…Rarely, the communication may be more downstream. [83][84][85] Because the defect is often large, it is not surprising that pulmonary vascular disease may develop early, similar to that seen in VSDs and patent ductus arteriosus. 82,83 Aortopulmonary window is associated with other cardiovascular malformations, such as VSDs, tetralogy of Fallot, subaortic stenosis, and infrequently, right aortic arch, ASD, or patent ductus arteriosus.…”

“…82,83 Aortopulmonary window is associated with other cardiovascular malformations, such as VSDs, tetralogy of Fallot, subaortic stenosis, and infrequently, right aortic arch, ASD, or patent ductus arteriosus. [83][84][85][86] …”

Aortopulmonary Window and Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery: Long-Term Result After Takeuchi-Type Repair

“…6 The surgical correction of the association of APW and anomalous origin of the RCA from the PA necessarily include the connection of the anomalous RCA ostium with the aorta to avoid myocardial ischaemia. Different techniques were employed for such purpose, such as transfer of the coronary ostium to the aorta, 9 rotation plastic procedure with pulmonary tissue patch, 10 directly closed. In the present case, we also employed the Takeuchi procedure, but we used autologous pericardium in alternative to the PTFE, and preferred to augment the PA with a second patch to prevent residual pulmonary stenosis.…”

Aortopulmonary window. Clinical and surgical assessment of 18 cases

“…In the literature, an anomalous origin from the pulmonary artery was the most common (10 of 15 cases). Among these 15 cases, the diagnosis was established in the pre-opera- volume 73, (nº 1), 1999 tive period in only two patients 32 this makes surgical correction even more difficult, since cardiopulmonary bypass is needed 33 . In our study, the association of APW and anomalous origin of the coronary artery from the pulmonary artery occurred in one patient and was diagnosed during surgery.…”