High take-off of right coronary artery: an extremely rare case of RCA anomaly

A 45-year-old man with a past history of aortic valve insufficiency presented with recently increasing chest discomfort. Coronary angiography revealed significant stenosis at the mid-portion of the left anterior descending artery and origin of the first obtuse marginal branch. The right coronary artery (RCA) was faintly seen to be free from significant stenosis. (Selective RCA angiography had not been possible.) At surgery while dissecting between the ascending aorta and the main pulmonary artery, the RCA ostium was incidentally found to be located approximately 10 cm above the aortic annulus and 5 cm above the sinotubular junction, between the medial curve of the ascending aorta and the main pulmonary artery. After coronary artery bypass grafts, we repaired the aortic valve and the RCA remained intact.