Anomalous Origin of Right Coronary Artery from Left Sinus of Valsalva, Still a Therapeutic Dilemma: A Case Presentation and Brief Review

Abstract An anomalous aortic origin of coronary artery (AAOCA) is a rare congenital anomaly which reported in 0.1% to 1% of the population in the literature. The most common subtype is anomalous aortic origin of right coronary artery (AAORCA) deriving from the left side. In the present case report, the therapeutic approach of AAORCA and the ongoing clinical dilemma will be discussed. A 52-year-old man was admitted with prolonged exertional chest pain and increased troponin I without any changes in electrocardiogram. After percutaneous catheterization, it revealed an ectasia in all left system coronary arteries and we suspected AAORCA. Hence, a coronary computed tomography angiography confirmed that the right coronary artery originated from the left sinus of Valsalva with a malignant interarterial course and a significant lesion at the ostium of left anterior descending. Hence, a coronary artery bypass grafting (CABG) with reimplantation of the orifice of AAORCA to the right coronary cusp was performed as a therapeutic approach. In the 12-month follow-up, the symptoms were ameliorated and there were no complications. As recommended in the American College of Cardiology/American Heart Association guidelines, patients with AAORCA should be divided into asymptomatic and symptomatic (ischemic symptoms. The patients with AAOCA who are symptomatic such as chest pain due to ischemia, ventricular arrhythmia with syncope, or aborted sudden cardiac death should have offered surgical management including unroofing, CABG, or reimplantation approaches. However, in accompaniment of AAORCA and other coronary artery disease, both CABG and translocation of AAORCA with reimplantation into a suitable origin maybe an appropriate surgical strategy with an acceptable mid-term follow-up as represented in our case.