Anomalous origin of the right coronary artery from the pulmonary trunk

Abstract

DESCRIPTIONA 55-year-old woman presented to cardiology clinic with chest heaviness, which worsened with walking and deep inspiration. The sensation of chest heaviness had lasted for about a year. Cardiac and chest auscultation were unremarkable. The patient's cardiovascular risk factors included treated hypertension. There was no family history of coronary artery disease. The patient's ECG demonstrated sinus bradycardia with no ST-segment changes and normal QRS morphology. Transthoracic echocardiography showed normal left ventricular systolic function with mild left ventricular hypertrophy and no valvular abnormality. Furthermore, stress echocardiography was negative for ischaemia at 80% of maximum heart rate. Subsequently, the patient was referred to CT cardiac angiography. The patient's calcium score was 0. Contrast angiography demonstrated that the right coronary artery (RCA) had originated from the pulmonary trunk (figures 1 and 2A). The origin of the left coronary artery was normal (figure 2B). Tortuous collaterals from the LAD to the inferior wall of the heart were noted (figure 2B). In neither the left main stem, left anterior descending artery, circumflex artery nor RCA was luminal stenosis identified. Furthermore, exercise stress echocardiography was conducted, which was negative for ischaemia. The patient's management was discussed at a joint cardiology and cardiothoracic meeting and it was decided to continue conservative treatment. However, further follow-up was advised.Coronary artery anomalies are present in up to 1% of the population and are classified into anomalies of origin, anomalies of the course and anomalies of termination.1 Ectopic origin of a coronary artery from the pulmonary trunk is part of a group of rare anomalies that carry a high risk of myocardial infarction and sudden death. Increased risk of Figure 1 Maximum intensity projection. The right coronary artery originates from the pulmonary trunk. RCA, right coronary artery.

Anomalous origin of coronary arteries from pulmonary artery in adults: a case series

“…Reimplantation of the RCA or LCA to the aorta into the correct aortic sinus is regarded as the treatment of choice. 1 , 2 An alternative option is to completely ligate the anomalous RCA or LCA and place a saphenous vein or an internal mammary artery graft. 9 , 10 In ARCAPA or ALCAPA, the prognosis after surgery is favourable, the ischaemic yet viable myocardium will recover post-operatively after reperfusion preventing long-term myocardial ischaemia and fibrosis, and the left ventricular function improves substantially.…”

“…Specifically, the anomalous origin of a coronary artery from the pulmonary trunk is a small group of rare anomalies leading to a high risk of myocardial infarction and cardiac arrest or sudden death. 1 …”

NASCI case of the month: a case of anomalous right coronary artery arising from the pulmonary artery

“…Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital abnormality with an estimated prevalence of two cases per 100,000 individuals [ 1 , 2 ]. Presentation and physical exam findings are variable but include chest pain, heart failure, myocardial infarction, and murmur with nonspecific ECG findings [ 1 , 2 ]. Associated cardiac anomalies are frequent, and prognosis is associated with the degree of collateralization with the normal coronary artery [ 1 , 2 ].…”

“…Presentation and physical exam findings are variable but include chest pain, heart failure, myocardial infarction, and murmur with nonspecific ECG findings [ 1 , 2 ]. Associated cardiac anomalies are frequent, and prognosis is associated with the degree of collateralization with the normal coronary artery [ 1 , 2 ]. Management depends on clinical factors, though surgical reimplantation is often the treatment of choice [ 1 , 3 ].…”

“…Associated cardiac anomalies are frequent, and prognosis is associated with the degree of collateralization with the normal coronary artery [ 1 , 2 ]. Management depends on clinical factors, though surgical reimplantation is often the treatment of choice [ 1 , 3 ].…”