B-8 | Unveiling the Uncommon: Anomalous RCA Originating from LAD in a Singular Coronary Artery Variant

Background: Anomalous origin of the right coronary artery (RCA) from the left anterior descending artery (LAD) is an exceptionally rare congenital anomaly, with less than a handful reported in the literature.Presentations range from exertional symptoms to incidental findings.Accurate identification is vital to guide management and mitigate risks.Methods: We present a 64-year-old male with hyperlipidemia, who presented with progressive exertional angina.Cardiac evaluations included echocardiography, nuclear stress testing, and coronary CT angiography, culminating in cardiac catheterization for definitive assessment.Results: Cardiac catheterization confirmed an anomalous RCA originating from the mid-LAD, coursing over the pulmonary artery to the right ventricle's free wall into the AV groove (Figure 1), confirming a single coronary artery from the left sinus, with no significant stenosis.Additional findings included mild coronary calcification in the LAD, moderate aortic insufficiency, a mildly dilated ascending aorta (4 cm), and preserved left ventricular function.The patient was managed conservatively with aspirin, statin, beta-blocker, and ACE inhibitor, remaining asymptomatic at follow-up.Conclusions: Management of anomalous RCA is dictated by symptomatology and risk.Conservative therapy with surveillance is appropriate for asymptomatic, low-risk patients, while symptomatic or high-risk cases may warrant surgical intervention or PCI.Comprehensive imaging is indispensable for accurate diagnosis and individualized care, underscoring the importance of tailored follow-up for congenital coronary anomalies.