Re-Implantation of an Anomalous Right Coronary Artery Arising from the Left Coronary Sinus and Coursing between the Great Arteries

The patient with a coronary artery anomaly remains a treatment dilemma. We present a 62-year-old woman who underwent re-implantation of her anomalous right coronary artery (ARCA) from the left coronary sinus and describe our techniques according to potential anatomic variations of ARCA. The ARCA from the left coronary sinus is increasingly being recognized as a cause of angina, acute myocardial infarction, syncope, and sudden death. We describe a case that was treated by direct coronary artery re-implantation into the right coronary sinus and suggest that this technique be the first considered when planning surgical correction. (J Card Surg 2009;24:120-121).