Coronary anomaly: anomalous right coronary artery originates from the left sinus of Valsalva and coursing between the pulmonary artery and aorta

Abstract

Coronary artery anomalies (CAAs) are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography (MSCT) detection. The most common coronary anomaly is the separating origin of left anterior descending coronary artery (LAD) and left circumflex artery (LCX) from the left sinus of Valsalva, and this variant is benign. Herein, we present three extremely rare cases of anomalous right coronary artery (RCA) detected incidentally during routine coronary angiography and confirmed by multi-slice computed tomography (MSCT) technique. All the anomalous right coronary artery coursed between the pulmonary artery and aorta. We discuss how to make an accurate diagnosis for appropriate management.

Right Anomalous Coronary Artery Origin: The Role of Multislice CT Angiography

“…The aberrant vessel may course posterior to the aorta (retroaorta), or between the ascending aorta and pulmonary artery (interarterial), prepulmonary artery (prepulmonic), or septal (subpulmonic). 5 (Figure 2) An interarterial course is associated with risk of myocardial ischemia ("malignant anomaly") because it generally occurs with: a small, slit-like orifice, acute angle takeoff, potential of compression between the great vessels during exercise, due to expansion of the aortic root and pulmonary artery trunk root, and the artery with the anomalous course can be the dominant artery. 6 Study of the proximal structures, including the takeoff portion, is important in formulating a treatment plan.…”

Acute ST-segment elevation myocardial infarction treated with delayed angioplasty in a patient with anomalous origin of the right coronary artery in the early phase after kidney transplantation

“…This case demonstrates a rare anomalous origin of RCA from the left sinus of Valsalva in a patient who underwent kidney transplantation complicated by an acute ST elevation myocardial infarction. This ectopic RCA is considered to be an independent risk factor for adverse cardiovascular events, and this lesion is usually a challenge for cardiologists [ 1 ]. To exclude a malignant course of RCA between the aorta and pulmonary artery, patients should undergo scheduled multi-slice computed tomography [ 2 ].…”