High take-off of the right coronary artery with intramural course associated with the persistence of the left superior vena cava

Abstract

We describe the case of a coronary artery with an intra-aortic course (a rare coronary anomaly) associated with the persistence of the left superior vena cava. The first finding could represent an important surgical risk factor and should be recognized before cardiac surgery; the latter is not yet reported in the literature. A modified surgical technique is described.

Anomalous “High Take‐Off” of the right coronary artery evaluated by coronary CT angiography

“…A high RCA take‐off above its cusp may be associated with hypoplastic orifice, intimal hyperplasia, transient compression between the great arteries by spasm, and dilatation of the right ventricular infundibulum [7]. Location and course of the anomalous RCA can determine the relative risk that it carries []. If an anomalous RCA courses between the aorta and the right ventricular outflow tract (RVOT), the likelihood of ischemia or infarction becomes relatively high due to compression of the artery between great vessels [7].…”

“…Different modalities have been utilized to evaluate such an anomaly, because many times the high RCA take‐off is misinterpreted or not well visualized on a single evaluation []. Transthoracic two‐dimensional echocardiography tends to be incapable of delineating any anomalous high take‐off from the coronary artery [12].…”