A Case of Anomalous Right Coronary Artery With Catastrophic Presentation

Anomalous coronary artery is a rare but potentially life-threatening alteration in the coronary vascular system that is related to an increased risk of myocardial ischemia, ventricular arrhythmias, heart failure, and sudden cardiac death (SCD). Here, we present the case of a young male who presented to the hospital after a witnessed sudden cardiac arrest. Bystander cardiopulmonary resuscitation was started immediately, and normal sinus rhythm was achieved after electrical cardioversion three times. He was admitted to the ICU for further care upon admission. A CT of the chest showed a potential vascular structure in between the aorta and the pulmonary trunk. He underwent cardiac catheterization, which identified minimal coronary artery disease with the anomalous takeoff of the right coronary artery from the left coronary cusp. A cardiac CT scan obtained also showed an anomalous right coronary artery (ARCA) with an inter-arterial course. After explaining available treatment options and obtaining informed consent, a surgical correction by cardiothoracic surgery was performed using the coronary artery bypass graft technique. The patient recovered well after the surgery and was discharged home. After two years of follow-up, he continued to live life normally without any symptoms. Early and accurate diagnosis of an anomalous coronary artery is imperative for timely intervention, as malignant coronary artery diseases can often have a catastrophic presentation with acute coronary syndromes, myocardial infarction, or SCD. We present here a case of successful diagnosis of ARCA and its prompt surgical correction using coronary artery bypass grafting technique in a young adult. Despite the availability of various other treatment options, our case underscores coronary artery bypass grafting as a viable choice for individuals with anomalous coronary arteries, particularly in urgent situations.