Anomalous aortic origin of right coronary artery from left coronary cusp: a management conundrum: a case report

Abstract

Background Coronary artery anomalies are characterized by an abnormality in the course or origin of three main coronary arteries. There needs to be more scientific evidence to promptly treat coronary artery anomalies with poorly understood prognostic implications, especially anomalous aortic origin of the right coronary artery from the left coronary cusp. Case presentation A 58-year-old Caucasian female presented multiple times over 6 months with atypical chest discomfort and palpitations. The treadmill exercise test demonstrated exercise-induced non-sustained ventricular tachycardia. A coronary angiogram revealed no obstructive coronary artery disease and an anomalous aortic origin of the right coronary artery from the left coronary cusp with an interarterial course. She was managed conservatively with medications, despite persistent recurrent symptoms. Conclusion It is essential to identify subtle symptoms and insidious onset of anomalous aortic origin of the right coronary artery symptoms as seen in our patient, which can contribute to significant morbidity. There are discrepancies in existing guidelines between different cardiovascular societies in managing selected subgroups of patients with anomalous aortic origin of the right coronary artery who do not have high-risk features, but continue to remain symptomatic.

Anomalous Right Coronary Artery Managed with Bypass and Proximal Ligation

“…Complications can result in arrhythmias and cardiac arrest. 4 Management strategies consist of medical and surgical options, with surgery recommended for patients with an anomalous artery from the left sinus or a symptomatic anomalous artery from the right sinus. 5,6 Surgical management ranges from percutaneous coronary intervention with stenting of the proximal RCA, right coronary translocation, and coronary artery bypass surgery.…”