Artéria coronária direita anômala com origem na artéria pulmonar e pericardite constritiva: uma associação inusitada

Abstract

The association of anomalous right coronary artery originating from the pulmonary artery and constrictive pericarditis has never been showed in the literature. We present the first case of this unusual association in a patient with right heart failure. After diagnosis, the patient was referred to surgery and underwent phrenic-to-phrenic pericardiectomy; graft implant of right internal thoracic artery to right coronary artery; and ligation of the anomalous origin of the right coronary artery from the pulmonary artery. Such procedures solved the potential risk of sudden death related to anomalous right coronary artery originating from the pulmonary artery and alleviated the symptoms of heart failure caused by constrictive pericarditis.

Anestesia Peridural Torácica Em Paciente Com Pericardite Constritiva

“…A liberação do coração restrito melhora a função cardíaca e leva à compensação e, na maioria dos casos, ao desaparecimento da insuficiência cardíaca. A sobrevida após a cirurgia depende da etiologia, e pacientes com pericardite constritiva idiopática tendem a evoluir melhor (SILVESTRE et al, 2013).…”

Thrombosis in the Surgically Corrected Anomalous Right Coronary Artery after Reimplantation in Aorta

“…Surgical correction of ARCAPA is recommended even in asymptomatic patients with good overall outcomes [ 1 , 3 , 10 , 12 – 14 ]. The most common surgical approach for this condition is to reimplant the anomalous RCA into the correct right aortic sinus.…”

Incidental finding of an ARCAPA during angiography

“…The onset of most symptoms is in the first decade of life, or there are no symptoms throughout the whole life, characterizing, in some cases, the malformation as a casual finding. [2][3][4][5][6][7][8][9] In the aforementioned case, the patient is oligosymptomatic from the cardiovascular point of view except for family complaint due to the advanced dementia. It is worth mentioning that he remained completely asymptomatic until the sixth decade of life, an uncommon fact to individuals with such findings.…”

“…Among the congenital heart diseases, the anomalous coronary artery origin is even more uncommon, and one of the most severe conditions, ranging from 0.2 to 1.5% in the general population, [1][2][3] while the anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is even rarer, with a prevalence of 0.002%. 1,[4][5][6][7][8][9] ARCAPA was first described in 1885 by St. John Brooks, in two cases of autopsy. [5][6][7][8] The natural course may be insidious if there is collateral coronary circulation, which, due to the low pulmonary resistance, allows the flow from the left to the right.…”