Quantitative Myocardial Perfusion in Surgically Repaired Coronary Artery Anomaly

The anomalous aortic origin of the right coronary artery with an intramural course is rare and can cause myocardial ischemia, for which surgical repair is indicated. We present the case of a 49-year-old man with this anomaly whose preoperative myocardial perfusion positron emission tomography revealed inducible ischemia. Comparison of the preoperative and follow-up (6 months) positron emission tomography findings showed significant improvement in regional myocardial flow reserve and relative flow reserve, in keeping with the improvement in symptoms. However, positron emission tomography/myocardial perfusion imaging findings were difficult to interpret.