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Myocardial infarction caused by anomalous origin of the right coronary artery (RCA) from the left coronary sinus

Anomalous origin of the RCA from the left coronary sinus with an interarterial course is a rare but clinically significant anomaly. It is found in only about 0.03–0.9% of patients undergoing coronary angiography. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, arrhythmias, and sudden death. We describe the case of a 16 years old girl with this anomaly who presented with a complaint of precordial pain while she was resting. The patient’s initial physical examination showed no abnormalities but electrocardiogram showed signs of inferior myocardial infarction. Her cardiac troponins were very elevated . She was treated conservatively and a few days later she was referred to our clinic for further evaluation. According her medical history coronary artery anomaly was suspected. ECHO showed normal origin and course left CA but we were not able to identify right CA origin. The function of both ventricle were normal.Stress myocardial perfusion scan with technetium 99m sestamibi revealed a small irreversible inferior defect. Exercise stress test was within normal limits. Coronary angiography documented the anomalous origin of the RCA from the left sinus of Valsava. MSCT coronary angiography confirmed anomalous origin of the right coronary artery from the left coronary sinus with course of the proximal part RCA between the aorta and pulmonary trunk. Our patient successfully underwent surgery (unroofing procedure).

Anomalous origin of the RCA; manifestations; treatment

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