Interarterial course of anomalous right coronary artery: Pathophysiology, diagnosis, and treatment

Anomalous coronary artery from the opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, and sudden cardiac death. Management of anomalous coronary artery from the opposite sinus varies; however, current guidelines suggest surgery in symptomatic patients. Our patient is a middle-aged male with a history of coronary artery disease and status post coronary artery bypass graft. He presented with complaints of vague chest pain. After a positive stress test, he was sent to the catheterization suite. Diagnosis of an anomalous right coronary artery from the left coronary sinus was made. The patient underwent surgical revascularization and was awaiting follow-up with cardiology at the time of study. A timely diagnosis of an anomalous coronary artery is critical in symptomatic patients because of the risk of sudden cardiac death, especially in patients with arteries with an interarterial course. This case demonstrates the importance of making the correct diagnosis, as appropriate surgical management can drastically improve outcomes.