Anomalous Origin of Right Coronary Artery from Ascending Aorta: MDCT Coronary Angiography Depiction Images

Abstract

A 46-year-old male presented with complaints of chest pain and dyspnoea on moderate exertion for the past month. The patient was a known case of type 2 diabetes mellitus and hypertension, and has been on treatment for the past five years. He was not a smoker or alcoholic. Suspecting coronary artery disease, a diagnostic work-up was performed. Blood investigations revealed dyslipidaemia. Electrocardiography (ECG) showed sinus rhythm with a limited right bundle branch block with ST-T changes. Echocardiogram showed biventricular dysfunction. Since the patient was reluctant to undergo catheter coronary angiography, a Computed Tomography (CT) Coronary angiogram was performed first. A 128-slice Multidetector Computed Tomography (MDCT) coronary angiography revealed an anomalous high origin of the Right Coronary Artery (RCA) arising from the anterior wall of the ascending aorta approximately 2 cm above the sinotubular junction at an acute angle of 45° [Table/Fig-1,2] [Video-1]. The anomalous RCA followed its normal course without any intramural course noted. Mixed plaques were observed in the RCA, with involvement distal to the acute marginal artery, causing a maximum of 90% stenosis or complete occlusion. The Left Coronary Artery (LCA) was found to be normal, arising from the left cusp of the coronary sinus and dividing into the left anterior descending artery and left circumflex artery. The left anterior descending artery showed significant stenosis in its proximal third. The left circumflex artery exhibited minimal coronary artery disease with no significant stenosis. Therefore, double-vessel coronary artery disease was diagnosed, and the patient was advised to undergo a revascularisation procedure. Currently, the patient is on medication and undergoing follow-up.

Keywords

• coronary artery disease
• dyspnoea
• myocardial ischaemia