Anesthetic management of two patients with anomalous origin of the right coronary artery who developed acute myocardial ischemia associated with Stanford type A acute aortic dissection.

Abstract

　We experienced two cases of Stanford type A acute aortic dissection (AoD) in patients with anomalous origin of the right coronary artery (RCA). In these two cases, the RCA originated anterior to the left coronary artery (LCA) on the left coronary cusp (LCC) side, coursed between the aorta and pulmonary artery toward the anterior aorta, and perfused the RCA area. The two patients presented with preoperative or intraoperative ischemic symptoms in the RCA area, although the RCA was not involved in the aortic dissection. AoD in patients with anomalous origin of the RCA can cause ischemic symptoms via unusual mechanisms. It is therefore important to confirm the origin and course of coronary arteries and the presence of dissection in coronary arteries as well as to observe any regional wall motion abnormalities and the treated area when using transesophageal echocardiography.