Anomalous Right Coronary Artery Origin-Juniper Publishers

JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF CARDIOLOGY & CARDIOVASCULAR THERAPY 

Keywords

Keywords: Coronary artery anomalies; Cardiac surgery; Chest pain

Case Report

A 59-year-old woman with a history of hypertension and mild asthma was brought to the emergency department complaining of acute onset chest pain. Electrocardiogram en-route by EMS showed ST-segment elevations in inferior leads, which normalized on arrival to the emergency department thirty minutes later. Initial serum troponin-T was 0.12ng/ml (reference range: 0.0-0.1ng/ml). Coronary angiography revealed a suspected culprit, apical "wraparound" distal LAD stenosis with vasospasm and a difficult to engage right coronary artery (RCA) with 40% ostial stenosis. Her symptoms improved with intravenous nitroglycerin. Coronary computed tomography angiography showed an anomalous RCA arising from a separate origin in the left sinus of valsalva, with an "intramural" (within the wall of the aorta) and "inter-arterial" course (between the aorta and pulmonary artery) (Figure 1 & 2). Given that the patient's EKG findings and presentation could also have been due to RCA compression and that the inter-arterial course of an anomylous RCA has historically been associated with a poor prognosis (even sudden cardiac death), she was referred for surgery [1,2]. The patient did well with a single vessel bypass of the RCA with a saphenous vein graft without recurrent chest symptoms.

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