Anomalous origin of the right coronary artery from the left coronary sinus - case report

The anomalous origin of the right coronary artery from the left coronary sinus is a rare congenital disorder and can often result in sudden death upon initial presentation. We report a 19-year-old male patient who was referred to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015 with multiple episodes of exertional angina. He was diagnosed as having an anomalous right coronary artery arising from the left coronary sinus following an intraoperative transesophageal echocardiogram. An unroofing ostioplasty of the anomalous right coronary artery was successful. Details of the surgical management of this anomaly are discussed

[Open] approach to aortic arch aneurysm repair

Aortic arch aneurysm is a relatively rare entity in cardiac surgery

Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task

The need to produce a relatively bloodless surgical field with circulatory arrest, while at the same time protecting the brain, is the hallmark of this challenge

However, a clear understanding of the topic allows a better and less morbid approach to such a complex surgery

Literature has shown the advantage of selective cerebral perfusion techniques in comparison with only circulatory arrest. Ability to perfuse the brain has allowed circulatory arrest temperatures at moderate hypothermia without the need for deep hypothermia

Even though cannulation site selection appears to be a minor issue, literature has shown that the subclavian/axillary route has the best outcomes and that femoral cannulation should only be reserved for no access patients. Although different techniques for arch anastomosis have been described, we routinely perform the distal first technique as we find it to be less cumbersome and easiest to reproduce

In this review our aim is to outline a systematic approach to aortic arch surgery

Starting with indications for intervention and proceeding with approaches on site of cannulation, approaches to brain protection with hypothermia and selective cerebral perfusion and finally surgical steps in performing the distal and arch vessels anastomosis

Saphenous vein graft vs. radial artery graft searching for the best second coronary artery bypass graft

Coronary artery bypass grafting [CABG] was first used in the late 1960s. This revolutionary procedure created hope among ischemic heart disease patients. Multiple conduits are used and the golden standard is the left internal mammary artery to the left anterior descending artery. Although all approaches were advocated by doctors, the use of saphenous vein grafts became the leading approach used by the majority of cardiac surgeons in the 1970s. The radial artery graft was introduced at the same time but was not as prevalent due to complications. It was reintroduced into clinical practice in 1989. The procedure was not well received initially but it has since shown superiority in patency as well as long-term survival after CABG. This review provides a summary of characteristics, technical features and patency rates of the radial artery graft in comparison with venous conduits. Current studies and research into radial artery grafts and saphenous vein grafts for CABG are explored. However, more studies are required to verify the various findings of the positive effects of coronary artery bypass grafting with the help of radial arteries on mortality and long-lasting patency.