Coronary Stent Placement in an Interarterial Anomalous Right Coronary Artery: An Alternative Approach in a...

Area of Science:

• Cardiology
• Congenital Heart Disease
• Interventional Cardiology

Background:

• Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital anomaly.
• AAOCA can be an etiology for sudden cardiac death, but clinical significance varies.
• Surgical management with coronary unroofing is the standard for symptomatic individuals, but not all cases are suitable for surgery.

Purpose of the Study:

• To report a unique case of anomalous right coronary artery with interarterial course managed with percutaneous coronary intervention (PCI).
• To describe a novel mechanism of aborted sudden cardiac death in a patient with AAOCA and severe comorbidities.

Main Methods:

• Case report of a patient with anomalous right coronary artery and interarterial course.
• Management with percutaneous coronary intervention due to surgical contraindications (comorbidities).
• Analysis of the proposed mechanism involving aggravated pulmonary hypertension.

Main Results:

• Successful management of symptomatic anomalous right coronary artery with PCI.
• Identification of a unique mechanism of aborted sudden cardiac death involving pulmonary hypertension in a patient with comorbid pulmonary disease.
• Demonstration of PCI as a viable alternative to surgery in select AAOCA cases.

Conclusions:

• Percutaneous coronary intervention can be a safe and effective alternative to surgery for managing anomalous aortic origin of a coronary artery in patients with contraindications.
• Aggravated pulmonary hypertension in patients with comorbid pulmonary disease can precipitate sudden cardiac death in the setting of anomalous aortic origin of a coronary artery.
• This case underscores the importance of considering individual patient factors and comorbidities when determining the optimal management strategy for anomalous aortic origin of a coronary artery.