Right Coronary Artery with an Intramural and Interarterial Course as a Unique Cause of Myocardial Ischemia: The Unroofing Method Might Still Be the Best Solution

• Published in: Internal Medicine Vol. 62; no. 5; pp. 745 - 749
• Main Authors: Aoki, Ryota, Kozai, Toshiyuki, Ono, Yoshiyasu, Tanaka, Fumiaki, Ueda, Yoko, Ikeda, Jiro, Matsuo, Atsutoshi, Hori, Hidetsugu, Hosokawa, Yukio, Okazaki, Teiji, Kosuga, Tomokazu, Yoshitake, Kiyonobu, Kosuga, Kenichi, Aoyagi, Shigeaki, Tayama, Keiichiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.03.2023; Japan Science and Technology Agency
• Subjects: Adult; Angiography; Aorta; Arteriosclerosis; Blood flow; Bypass; Case Report; Cerebral blood flow; Computed tomography; Constriction, Pathologic - complications; Coronary Angiography - adverse effects; coronary anomaly; Coronary artery; Coronary Artery Disease - complications; Coronary Vessel Anomalies; Heart surgery; Hematoma; Humans; Inflammation; Internal medicine; Ischemia; Male; Myocardial Ischemia; Stenosis; coronary anomaly; myocardial ischemia
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.0127-22

A 39-year-old man was admitted because of cardiac arrest. Emergent coronary angiography revealed a preserved coronary blood flow; however, multiple-row detector computed tomography (MDCT) revealed that the proximal right coronary artery (RCA) was running inside the aortic wall, creating proximal stenosis without atherosclerotic changes. Surgical intervention with unroofing was performed; however, postoperative stenosis of the proximal RCA required additional coronary artery bypass grafting (CABG). Intraoperative findings during CABG did not reveal hematoma or coronary dissection. However, MDCT one year after CABG depicted improvement of the RCA and graft stenoses, suggesting that the post-unroof stenosis may have been caused by an inflammatory reaction after surgical intervention.