Management of a Patient With an Anomalous Right Coronary Artery: A Case Report

Coronary artery anomalies are rare congenital defects that involve abnormalities in the origin, course, or termination of the three main epicardial coronary arteries. Due to the variety of aberrant coronary artery defects, the clinical presentation can differ. Anomalous origins of the right coronary artery include the pulmonary trunk, ascending aorta, left sinus of Valsalva, and a course that traverses between the great vessels. Diagnosis is made using multidetector computed tomography coronary angiography or coronary computed tomography angiography. Management may include lifestyle modifications, medications, or invasive surgical interventions. Here, we present the case of a 65-year-old woman with recurrent angina, leading to multiple emergency visits and hospitalizations. The patient was ultimately diagnosed with an anomalous right coronary artery, with a high takeoff originating anteriorly above the sinus of Valsalva and traversing normally after a short segment between the aorta and the main pulmonary artery. This case highlights the complex and controversial management of anomalous coronary arteries and underscores the need for further research to establish optimal, guideline-directed treatment strategies.