Anatomical and physiological assessment of a symptomatic anomalous origin of the right coronary artery from the pulmonary artery by noninvasive imaging examinations

Abstract

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is an extremely rare congenital disease with an estimated prevalence of 0.002% [1]. Recent advancement of diagnostic imaging modality has increased the diagnostic yield for congenital cardiovascular malformations, and the number of the case reports of ARCAPA has increased since the first case report described by Brooks in 1885 [2]. However, it is still difficult to diagnose this uncommon congenital disease because of its generally asymptomatic nature, and most of the cases of ARCAPA are incidentally or unexpectedly diagnosed in the diagnostic process of other cardiac/noncardiac diseases. We present a long-year symptomatic ARCAPA, anatomically and physiologically diagnosed by using transthoracic echocardiography (TTE) and coronary computed tomography angiography (CCTA).

Cardiac imaging findings in anomalous origin of the coronary arteries from the pulmonary artery; narrative review of the literature

“…The left coronary artery is usually enlarged and tortuous and collateral arteries are present in the ventricular septum as seen in ALCAPA. Wall motion abnormalities in ventricles can also be seen in TTE [ 4 , 6 , 10 – 14 , 28 , 32 ]. When there is a dilated LCA and continuous or diastolic retrograde flow from an anomalous vessel to the pulmonary artery, ARCAPA can be mistaken for a coronary fistula.…”

“…Echocardiography, multislice computed tomography angiography (CTA), and magnetic resonance angiography (MRA) are generally used to diagnose ARCAPA. Patients with ARCAPA are usually asymptomatic and may be incidentally detected when undergoing paraclinical examinations for other problems, a common example is a coronary angiography following chest pain [ 3 , 4 ].…”