A Case Series of Right Coronary Artery Anomalies With a Malignant Course

Anomalous aortic origin of the right coronary artery (AAORCA) is a rare congenital anomaly. Although most patients with this anomaly remain asymptomatic, it is well established that this anomaly may lead to angina, myocardial infarction (MI), or sudden cardiac death (SCD) in the absence of atherosclerotic disease. In this article, we report three cases in the Middle East that presented with syncope in two patients, as well as diaphoresis and ECG changes during a nasal septoplasty surgery in the third. All patients were diagnosed with AAORCA with interarterial course using coronary computed tomography angiography (CTA) after initial evaluation. Although medical management varied over the three cases, all patients tolerated medical management and were referred for surgical interventions. One patient underwent a surgical procedure, with positive outcome afterwards. It is important to recognize the atypical presentations of the malignant course of AAORCA and demonstrate the importance of medical and surgical management in this disease, specially in understudied areas such as the Middle East.