Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery With Aortopulmonary Window

Abstract

This report describes a rare case of anomalous origin of the right coronary artery from the pulmonary artery associated with a large aortopulmonary window in a 2-month-old boy. The right coronary artery was exposed to systemic pressure and carried fairly well-oxygenated blood to the myocardium. Closure of the aortopulmonary window alone could have caused acute myocardial ischemia. The purpose of this case report is to describe successful diagnosis and management of anomalous origin of the right coronary artery associated with an aortopulmonary window. The pathological findings and the physiological effects, clinical importance, and method of correction used are discussed.

Aortopulmonary Window With Anomalous Coronary Arteries

“…Aortopulmonary window is rarely associated with an anomalous origin of one coronary artery. The association of APW and the anomalous origin of the right coronary artery from the pulmonary artery has been reported frequently . However, APW is rarely associated with the anomalous origin of both coronaries or the left coronary artery from the pulmonary artery …”

Aortopulmonary window with anomalous origin of the right coronary artery from the pulmonary trunk

“…Moreover, in the case of poor intercoronary collateral circulation, isolated repair of APW may result in acute ischemia in the RCA blood supply region. 4 It is challenging to diagnose coronary anomalies on transthoracic echocardiography (ECHO) because both large arteries are filled together. In most suspected cases, the diagnosis is made angiographically or intra-operatively during the surgical repair of the aortopulmonary window.…”