Anomalous Origin of RCA in a young symptomatic patient

:Comments
1- Dr Babazadeh , Tehran
Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital disease. It is mostly benign, with malignant variants reported in a few instances. One such “malignant course” is its course between the main pulmonary artery and the aortic root. It is relatively uncommon but may present with angina or sudden cardiac death (SCD) in the absence of significant atherosclerosis, especially in young patients. Therefore, diagnosis becomes pivotal.

Anomalies of Course
The course of the abnormal vessel is a risk modifier in patients with anomalous coronary artery origin from the aorta. Whereas subpulmonic, prepulmonic, retroaortic, and retrocardiac courses have not been associated with SCD, an interarterial course is considered malignant and is often associated with other high-risk anatomic features (eg, slit-like ostium, intramural tract)

The interarterial course is considered the most malignant anomaly of coronary artery course, and surgical correction is usually indicated. The choice of surgical technique depends mostly on the origin of the anomalous vessel and the extent of the intramural tract.