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This rare congenital anomaly is seen in 0.024%-0.066% of patients who undergo CCA and is characterized by a single coronary ostium originating from the aortic sinus (Fig.
In this condition there is complete atresia of the left coronary ostium, so the entire coronary arterial supply to the heart is derived from the RCA and its branches.
For type A coronary malperfusion, the coronary ostium was repaired with a continuous 6-0 over-and-over suture conjoining the dissected arterial layers, leaving the ostium in continuity with the aortic wall or directly anastomosing the ostial button to the tube graft.
The third reason was due to failed cannulation of the coronary arteries, in 08 patients (17%).This was caused by either a right subclavian artery that was either tortuous or had an aberrant origin or major aortic arch dilatation making it difficult to manipulate the catheter into the coronary ostium.
(18) added that the more central location of the left coronary ostium is justified, because, after its origin, the left coronary artery heads to the space between the pulmonary trunk and the left auricle, branching immediately after that.
In most cases, it has been attributed to the use of ostial cannulation for antegrade cardioplegia during surgery, which can cause a mechanical injury to the coronary ostium resulting in hyperplastic reaction and stenosis [5, 7, 8].
The study was remarkable for the presence of a dilated right coronary ostium. No previous imaging was available for comparison, reflecting the remote nature of the patients' previous surgery.
The larger disk closed the ostium of the aneurysm completely while keeping a safe distance from both the aortic valve and the right coronary ostium. Complete covering of the mouth of the aneurysm is suggested to be better compared to plugging only the rupture site.

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