Anomalous Right Coronary Artery : A Multimodality Hunt for the Origin

Abstract EN

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital anomaly.

Although there have been several cases of ARCAPA reported in the literature, we present a case which highlights the challenges of diagnosing this rare condition and the incremental value of using multiple imaging modalities.

A healthy 48 year old female presented with angina and exertional shortness of breath.

She had a normal cardiovascular examination, negative cardiac enzymes and an unremarkable chest X-ray.

She did, however, have T-wave inversions in leads V1–V3.

Transthoracic echocardiography (TTE), as the first imaging investigation, led to an initial provisional diagnosis of a coronary-cameral fistula.

It showed unusual colour Doppler signals in the right ventricle and a prominent pattern of diastolic flow within the right ventricular myocardium, especially along the interventricular septum.

A subsequent multimodality approach, correlating images from angiography, CT and MRI was instrumental in confirming the diagnosis of ARCAPA and planning for surgical correction.

Cardiac CT and MRI are non-invasive, three-dimensional imaging modalities with high diagnostic accuracy for coronary artery anatomic anomalies.

If echocardiography and conventional angiography have been inconclusive, cardiac CT and MRI are especially important diagnostic tools.