High Risk Features of an Anomalous Origin of the Right Coronary Artery

Area of Science:

• Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Anomalous aortic origin of the coronary arteries (AAOCA) is a rare congenital abnormality.
• It is often asymptomatic, found incidentally, but can cause sudden cardiac death (SCD), especially in young athletes.
• AAOCA is the second most common cause of SCD in young athletes.

Observation:

• A 39-year-old patient presented with life-threatening symptoms suggestive of SCD.
• Initial diagnostics including ECG, echocardiography, and cardiac markers were normal.
• Coronary CT revealed a left-sided right coronary anomaly with hypoplasic origin and high-risk course between the aorta and pulmonary artery.

Findings:

• The anomalous coronary artery originated from the left sinus of Valsalva.
• It had a hypoplastic origin and a dangerous intramural path.
• The patient exhibited multiple high-risk features for SCD.

Implications:

• This case underscores the importance of advanced imaging like coronary CT in diagnosing high-risk AAOCA.
• Surgical management, such as coronary artery bypass, can be effective in preventing SCD in symptomatic patients.
• Early identification and intervention are crucial for patients with symptomatic AAOCA.