Clinical case of Surgical Treatment of Coronary Heart Disease in an Adult Patient with the Anterior Descending Artery Originating from the Right Sinus of Valsalva

Abstract

Аbnormal coronary artery origins can occur both in isolation and in combination with congenital heart defects. In the vast majority of cases, such anomalies can affect the deterioration of coronary blood flow with ischemic manifestations. The report describes effort angina in an adult patient who in the childhood underwent operation for the congenital heart defect because of inter-arterial compression of the left anterior descending artery originating with a separate mouth from the right sinus of Valsalva. The purpose of this study is to evaluate the outcome of surgical treatment of coronary heart disease in a patient with abnormal origin of the left anterior descending artery, bicuspid aortic valve and aortic root dilatation. Materials and methods. The paper presents the result of surgical treatment of a patient with abnormal origin of the left anterior descending artery, bicuspid aortic valve and aortic root dilatation, surgical myocardial revascularization in coronary heart disease. It describes the results of instrumental methods, the choice of treatment and control remote results of the operation. Results and discussion. A 43-year-old patient with complaints of angina pectoris underwent instrumental studies such as coronary angiography, bicycle ergometry, computer coronary angiography with comparison of their results. A surgical way of correction of impaired coronary blood flow on the left anterior descending artery was chosen by performing mammary coronary bypass surgery on a beating heart. During the re-examination after 3 months, the patient had no complaints of chest pain, and repeated bicycle ergometry revealed no data on myocardial ischemia. Conclusion. Thus, this clinical case clearly demonstrates the necessity of understanding congenital heart defects, their pathological anatomy and comparison with findings of all clinical and instrumental examinations in the diagnosis and treatment of coronary heart disease in patients with congenital heart defects and abnormal coronary artery origin. Only a comprehensive approach to such patients will provide an opportunity for rapid and correct diagnosis, accordingly, for the choice of adequate treatment.