[Successful patch angioplasty for the right coronary artery dissection following selective coronary perfusion].

A case of successful patch angioplasty for the right coronary artery (RCA) orifice dissection following selective coronary perfusion is reported. A 56-year-old woman who had mitral restenosis, aortic stenosis, and atrial fibrillation with bradycardia-tachycardia syndrome was referred to our hospital for operation. The operation, which contained aortic valve replacement and mitral commissurotomy, was performed with hypothermic cardiopulmonary bypass and crystalloid cardioplegic arrest. The ascending aorta was opened, and selective coronary perfusion was performed. The right coronary cannula was difficult to insert and dislodged several times. At the second infusion of the cardioplegic solution, the right coronary orifice and ascending aortic wall was dissected. The dissection extended to the proximal RCA. The aortotomy was extended into the RCA beyond its orifice. The Xenomedica pericardial patch was used to enlarge the diameter of the RCA with closing the dissected cavity. Then the patch was brought onto the side of the aorta and the aortotomy was closed in the usual manner. Post operative coronary angiography revealed widely patent RCA orifice and good runoff. Two years after operation the patient is free of angina with unlimited physical activity.