Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Dec 19:2018:2583918.
doi: 10.1155/2018/2583918. eCollection 2018.

Anomalous Origin of a Right Coronary Artery from Pulmonary Artery

Muhammad Shabbir Rawala  1 , S Tahira Shah Naqvi  2 , Kinaan Farhan  2 , Muhammad Yasin  1 , Syed Bilal Rizvi  3
Affiliations
Case Reports

Anomalous Origin of a Right Coronary Artery from Pulmonary Artery

Muhammad Shabbir Rawala et al. Case Rep Cardiol. .

Abstract

Congenital defects of the coronary arteries are noted in 0.2-1.4% of the general population. The first case of an anomalous origin of right coronary artery from pulmonary artery (ARCAPA) was described by Brooks in 1885. ARCAPA has an overall incidence of 0.002% in the general population. Most of the cases are asymptomatic; however, it can lead to serious complications such as heart failure, ischemia, and sudden death. A 57-year-old man presented to the cardiologist's office with complaints of shortness of breath and fatigue. The patient also had a previous history of coronary stents and heart failure. Initially, he was evaluated with a stress test which was reported as abnormal. The patient then underwent an invasive coronary angiography that revealed anomalous origin of the right coronary artery (RCA) and multivessel disease. Cardiothoracic surgery evaluated the patient and coronary artery bypass graft was performed. During the surgery, the anomalous origin of RCA from the pulmonary artery was identified and was successfully corrected by reimplanting the RCA into the ascending aorta. The anomalous origin of RCA is a rare yet life-threatening condition. The RCA due to its location of origin from the pulmonary artery tends to be a low-pressure vessel with a very thin and fragile wall. It also serves as a retrograde venous conduit from the left coronary circulation into the pulmonary artery. This connection results in a left-to-right shunt that explains the increase in oxygen saturation in the pulmonary artery and the high cardiac output which is normally seen in these cases. The clinical presentation can vary from coronary ischemia to heart failure or sudden death. Therefore, surgical correction is recommended even in asymptomatic patients. We present a case of an anomalous origin of RCA from the pulmonary artery which, unlike the origin of left coronary from pulmonary artery, is very rare. Patients with this condition should have early correction even if they are asymptomatic in order to prevent long-term complications.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Echocardiogram showing moderate dilation of the left ventricle and mildly reduced ejection fraction.
Figure 2
Figure 2
Catheterization showing the posterior descending artery and posterior left ventricular artery branches of the right coronary artery from the pulmonary artery (arrow).
Figure 3
Figure 3
Catheterization showing the posterior descending artery and posterior left ventricular branches of the right coronary artery.
See this image and copyright information in PMC

References

    1. Williams I. A., Gersony W. M., Hellenbrand W. E. Anomalous right coronary artery arising from the pulmonary artery: a report of 7 cases and a review of the literature. American Heart Journal. 2006;152(5):1004.e9–1004.e17. doi: 10.1016/j.ahj.2006.07.023. - DOI - PubMed
    1. Brooks H. S. J. Two cases of an abnormal coronary artery of the heart arising from the pulmonary artery: with some remarks upon the effects of this anomaly in producing cirsoid dilatation of the vessels. Transactions of the Academy of Medicine in Ireland. 1885;3:p. 447. - PMC - PubMed
    1. Bajwa A., Gupta B., Ya’qoub L., Laster S. B., Thompson R. Thrombosis in the surgically corrected anomalous right coronary artery after reimplantation in aorta. Case Reports in Cardiology. 2017;2017:4. doi: 10.1155/2017/5832692.5832692 - DOI - PMC - PubMed
    1. Jaworski R., Kansy A., Laniewski-Wollk P. Anomalous origin of circumflex coronary artery from right pulmonary artery in a hypoplastic left heart syndrome child. Polish Journal of Cardio-Thoracic Surgery. 2014;11(2):210–212. doi: 10.5114/kitp.2014.43853. - DOI - PMC - PubMed
    1. Dodge-Khatami A., Mavroudis C., Backer C. L. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. The Annals of Thoracic Surgery. 2002;74(3):946–955. doi: 10.1016/S0003-4975(02)03633-0. - DOI - PubMed

Publication types

LinkOut - more resources