Management of Anomalous Right Coronary Artery in a Patient With Mitral Valve Prolapse

This video is part of Dr. Vince Gaudiani’s Anomalous Right Coronary Artery Series. View more videos from this series here.   

The patient was a 55-year-old woman with mitral valve prolapse. Additionally, an angiogram revealed that she had an anomalous right coronary artery (RCA) origin.  

A diagram was used to explain the pathology of an anomalous RCA, highlighting the dangers and abnormalities and those that are not. Dr. Gaudiani explained the danger of an anomalous RCA without adventitia, as it arises from the left main coronary ostia. The issue with the anomalous RCA is the absence of adventitia, which can lead to vessel occlusion.  

A patient example was shown with bileaflet prolapse. Femoral venous cannulation was performed, followed by an upper ministernotomy and normal 18 French aortic cannulation. Once on bypass, the coronary artery was dissected out. The aorta was opened, and the orifices for the coronary artery were examined. A rooftop incision was made to enable the repair of the mitral cleft. After the mitral repair, the coronary artery was transected and oversewn, and the RCA was then reimplanted into the aorta.  

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