Anomalous Right Coronary Artery in Adult

Author: Alison F. Ward, MD
Institution: Emory University
Date Reviewed: 2022
Original Case: Jamil Borgi, MD / University of Washington
Learning Domain: Adult Cardiac Surgery
Learning Objective: Aortic Stenosis
PowerPoint File: File AS_updated3.6.pptx

 

Discussion Points

  • Indications for aortic valve replacement
  • Anatomic variations of AS—tricuspid vs bicuspid, associated thoracic aortic aneurysm
  • Risk stratification: STS score / EURO score
  • Heart team decision—TAVR vs SAVR
  • Valve choices
  • Patient prosthesis mismatch
  • Need for root enlargement
  • Anesthetic priorities

 

Learning Points

  • Management of severe aortic stenosis should involve a heart team approach  to determine optimal timing of intervention and selection of SAVR vs TAVR
  • Valve selection should determined factoring in age of patient, need for anticoagulation, valve durability, and optimal valve size
  • PPM should be avoided by implanting a valve with iEOA >0.85 cm2 /m2 or performing a root enlargement to allow implantation of large enough valve to avoid PPM