Coronary CTA identification of a super-dominant right coronary artery in a child case report

This case describes an asymptomatic child with incidental identification of a supradominant right coronary artery with absent left circumflex coronary artery. The coronary variant was identified due to concern for an unexplained, dilated right coronary artery demonstrated initially during an evaluation for a functional heart murmur. Cardiac CTA provided a non-invasive diagnosis of the coronary variant. This variant is mostly thought to be benign though some have reported concern for associated exertional ischemia. Our patient is asymptomatic with no segmental wall motion abnormalities. Supradominant right coronary artery with absent left circumflex coronary is therefore a variant therefore which may create concern when partially visualized on echocardiography but cardiac CTA can provide reassurance against potentially ominous diagnoses such as coronary fistula or prior Kawasaki disease. This variant likely has no ischemic effects though rarely some reports suggest a mechanism of ischemia which warrants long term follow up.