ANOMALOUS ORIGIN OF THE RIGHT CORONARY-ARTERY FROM THE PULMONARY TRUNK - IS SURGICAL REIMPLANTATION INTO THE AORTA A METHOD OF CHOICE

The origin of the right coronary artery (RCA) from the pulmonary trunk (PT) is a rare congenital anomaly. Although most of the patients rema in asymptomatic, prophylactic reimplantation of the RCA into the aorta has been recommended to prevent an adverse outcome. The report descri bes postoperative results in two patients following uneventful RCA rei mplantation. A 47-year-old man, with coexisting diffuse atheroscleroti c involvement of the left coronary artery, remained symptomatic despit e the establishment of a two-coronary system. The second patient, a 36 -year-old woman, with isolated anomalous origin of the RCA from the PT , continued to present with myocardial ischemia on exertion. The origi nal observation of an angiographic ''slow-flow'' phenomenon in the rei mplanted RCA in both patients implies the impairment of myocardial mic rovessels. These findings give rise to the question of whether the rei mplantation of the anomalous artery is really superior to simple ligat ion of its origin in order to relieve the ''coronary steal'' effect.