Anomalous aortic origin of right coronary artery from left coronary cusp: a management conundrum: a case report
Pramukh Arun Kumar1, Boskey Patel2, Mahati Dasari3
1Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA. pramukharunkumar@gmail.com.
Insights
Anomalous aortic origin of the right coronary artery can cause significant morbidity. Early identification of subtle symptoms is crucial for managing this coronary artery anomaly, especially in symptomatic patients without high-risk features.
Area of Science:
- Cardiology
- Medical Diagnostics
- Anatomical Variations
Background:
- Coronary artery anomalies involve abnormal origin or course of major coronary arteries.
- Anomalous aortic origin of the right coronary artery from the left coronary cusp has unclear prognostic implications.
- Limited evidence exists for prompt treatment of coronary artery anomalies with poorly understood prognoses.
Background:
Coronary artery anomalies are characterized by an abnormality in the course or origin of three main coronary arteries. There needs to be more scientific evidence to promptly treat coronary artery anomalies with poorly understood prognostic implications, especially anomalous aortic origin of the right coronary artery from the left coronary cusp.
Case Presentation:
A 58-year-old Caucasian female presented multiple times over 6 months with atypical chest discomfort and palpitations. The treadmill exercise test demonstrated exercise-induced non-sustained ventricular tachycardia. A coronary angiogram revealed no obstructive coronary artery disease and an anomalous aortic origin of the right coronary artery from the left coronary cusp with an interarterial course. She was managed conservatively with medications, despite persistent recurrent symptoms.
Conclusion:
It is essential to identify subtle symptoms and insidious onset of anomalous aortic origin of the right coronary artery symptoms as seen in our patient, which can contribute to significant morbidity. There are discrepancies in existing guidelines between different cardiovascular societies in managing selected subgroups of patients with anomalous aortic origin of the right coronary artery who do not have high-risk features, but continue to remain symptomatic.
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