[Anomalous origin of the right coronary artery from the pulmonary artery: a case report]

The abnormal origin of the right coronary artery from the pulmonary trunk is currently one of the most significant coronary anomalies that is not associated with diffuse atherosclerotic involvement. Because of the lack of specific symptoms, it is often the outcome of casual observation during heart surgery or autopsy. At times, the patients die of congestive heart failure or sudden death without even having had this anomaly diagnosed. We describe the case of a 41-year-old woman who came under our observation due to palpitations, both at rest and under stress, that were also associated with chest pain at times. Clinical and instrumental investigation revealed the abnormal origin of the right coronary artery from the pulmonary trunk, indicating that the symptoms were probably caused by intracoronary or intercoronary "stealing". The primary treatment of this pathology is based on surgical techniques, and it is constituted by the simple ligation of the anomalous vessel or the ligation of the right coronary artery, with saphenous vein by-pass grafting or the reimplantation of the right coronary artery into the aorta. We opted for reimplantation of the anomalous vessel into the aorta: a three-year follow-up has shown very good results, with complete disappearance of the symptoms.