CTV02 - Recurrent angina secondary to a right anomalous coronary artery with an intraarterial course

Introduction/Purpose: The incidence of an anomalous right coronary artery originating from the left sinus has been estimated to be 0.92%. An anomalous right coronary artery arising from the right sinus following an intraarterial course has an even smaller incidence approximated to be between 0.026% to 0.250%. An anomalous coronary artery with an intraarterial course has been linked to sudden cardiac death in young athletes undergoing extreme exercise. Although the risk of sudden cardiac death is less likely in older patients, these patients may still present with symptoms of ischemia. The management of a right anomalous coronary artery is still widely debated between medical treatment, percutaneous coronary intervention, and surgical repair.



Methods or Case Description: Our patient is a 63-year-old African American female with a right anomalous coronary artery with an intraarterial course which was initially treated with medical management but continued to present to the local emergency department complaining of recurrent angina. Due to her symptomatic presentation and high-risk course of the anomalous right coronary artery, she was deemed a surgical candidate three years after the initial diagnosis.

Outcomes: The patient tolerated the right coronary artery bypass graft well. On the patient’s most recent outpatient cardiology follow-up, she has been asymptomatic and has been doing well six months after coronary artery bypass graft surgery. She is now enrolled in a cardiac rehabilitation program.



Conclusion: Although many anomalous coronary arteries present asymptomatically and are found incidentally, a strong clinical picture and further evaluation are needed to fully decide on a management strategy. This case highlights a rare case of an anomalous right coronary artery with an intraarterial course in a symptomatic patient with no prior history of atherosclerotic coronary artery disease. It also follows her clinical management and discusses the importance of determining if patients with a similar clinical scenario are candidates for surgical management.