In cardiac surgery requiring cardiopulmonary bypass, the aortic cannula is placed in the ascending aorta and the venous cannula in the right atrium. The right coronary artery originates from which sinus of Valsalva, and why is this important during aortic root surgery?

• A Right coronary sinus (anterior sinus); right coronary ostium must be identified and protected or re-implanted during valve replacement or Bentall procedure ✓
• B Left posterior sinus; left coronary artery must be protected during mitral valve surgery
• C Non-coronary (posterior) sinus; the non-coronary cusp faces the inter-atrial septum
• D Right coronary sinus; the right coronary artery is routinely sacrificed in valve surgery without consequence

Explanation

The right coronary artery originates from the right (anterior) sinus of Valsalva, and the left main coronary artery from the left (left posterior) sinus; the non-coronary (posterior) sinus faces the inter-atrial septum and gives no coronary artery. During aortic root surgery (Bentall procedure or Ross procedure), the coronary ostia must be identified, excised with a button of aortic wall, and re-implanted into the Dacron graft or pulmonary autograft to maintain coronary perfusion. Failure to protect these leads to perioperative myocardial infarction.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.