Anomalous Aortic Origin of the Right Coronary Artery: A Case Report and Review of the Literature

Juthipong Benjanuwattra; Mahmoud Abdelnabi; Natnicha Leelaviwat; Annia Cavazos; Pooja Sethi; Leigh Ann Jenkins

doi:10.12890/2022_003692

Anomalous Aortic Origin of the Right Coronary Artery: A Case Report and Review of the Literature

Eur J Case Rep Intern Med. 2022 Dec 16;9(12):003692. doi: 10.12890/2022_003692. eCollection 2022.

Authors

Juthipong Benjanuwattra¹, Mahmoud Abdelnabi^{1

2}, Natnicha Leelaviwat¹, Annia Cavazos¹, Pooja Sethi³, Leigh Ann Jenkins³

Affiliations

¹ Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
² Cardiology and Angiology Unit, Department of Clinical and Experimental Internal Medicine, Alexandria University, Alexandria, Egypt.
³ Department of Cardiology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.

Abstract

Patients with symptomatic or malignant anomalous aortic origin of the right coronary artery (AAORCA) warrant surgical treatment to decrease morbidity and mortality. Various surgical techniques have been implemented including unroofing, reimplantation and bypass grafting. A 43-year-old woman presented with intermittent chest pain due to malignant AAORCA and received saphenous bypass grafting, instead of reimplantation, due to intraoperative spasm.

Learning points: Various surgical methods are available for the management of anomalous aortic origin of the right coronary artery (AAORCA), preferably unroofing when the intramural segment can be identified.Hypoplasia of the proximal segment, an acute take-off angle, and close proximity to the intercoronary pillar or commissure are limitations to unroofing, and alternative approaches are more appropriate.Coronary artery bypass graft, with either arterial or venous graft, can be performed when unroofing and reimplantation are not feasible. Measuring the distal anastomosis flow may help with a decision regarding native coronary artery ligation. It remains undetermined whether arterial or venous grafts provide superior outcomes.

Keywords: AAORCA; Anomalous aortic origin of the right coronary artery; coronary artery bypass graft; reimplantation; unroofing.