Anomalous origin of the right coronary artery from the main pulmonary artery. A case report

Area of Science:

• Cardiology
• Congenital Heart Disease
• Vascular Anatomy

Background:

• Anomalous origin of the right coronary artery from the main pulmonary artery (ARCAPA) is a rare congenital coronary artery anomaly.
• This anomaly can lead to myocardial ischemia, heart failure, and sudden cardiac death, particularly in pediatric populations.
• However, the clinical presentation and management in adults, especially asymptomatic individuals, remain less defined.

Observation:

• A 59-year-old asymptomatic woman was diagnosed with ARCAPA via catheterization and angiocardiography.
• The diagnostic workup revealed no signs of impaired left ventricular perfusion or function.
• Despite the anomaly, the patient remained asymptomatic throughout the observation period.

Findings:

• The diagnosis of ARCAPA was confirmed using advanced imaging techniques.
• The absence of symptoms and preserved left ventricular function were key factors in the management decision.
• Long-term follow-up demonstrated the patient's sustained asymptomatic status for eight years.

Implications:

• This case suggests that conservative management may be a viable option for select asymptomatic adult patients with ARCAPA.
• It underscores the importance of comprehensive functional assessment rather than solely relying on anatomical diagnosis for surgical indications.
• Further research is warranted to establish clear guidelines for managing asymptomatic ARCAPA in adults.