Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

HomeRadiologyVol. 301, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyAnomalous Origin of the Right Coronary Artery from the Pulmonary ArterySong Peng, Huaping Liu Song Peng, Huaping Liu Author AffiliationsFrom the Department of Radiology, Third Xiangya Hospital, Central South University, Tongzipo Road 138, Changsha 410013, China.Address correspondence to H.L. (e-mail: [email protected]).Song PengHuaping Liu Published Online:Sep 28 2021https://doi.org/10.1148/radiol.2021211186MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Online supplemental material is available for this article.An 80-year-old woman was diagnosed with poorly differentiated gastric adenocarcinoma. Preoperative electrocardiography showed a complete right bundle branch block. Coronary CT angiography showed an anomalous origin of the right coronary artery from the pulmonary artery, collateralization between the left coronary artery and the right coronary artery, and a coronary steal phenomenon, which is caused by low pulmonary artery pressure and blood flowing back from the coronary artery to the pulmonary artery (1) (Figure, Movie [online]). The patient’s systolic and diastolic left ventricular function at coronary CT angiography, pulmonary arterial pressure at catheterization, and troponin blood levels were normal. The patient’s left coronary artery was able to supply the entire heart without causing symptoms, mainly because of the rich collateral circulation between the left coronary artery and the right coronary artery, normal pulmonary artery pressure, and mild coronary atherosclerosis (2). She underwent partial gastrectomy and recovered uneventfully.Coronary CT angiograms in 80-year-old woman with anomalous origin of right coronary artery from pulmonary artery. Ao = aorta, PA = pulmonary artery, RCA = right coronary artery. (A) Cinematic rendering shows anomalous origin of right coronary artery from pulmonary artery, with rich collateral circulation (arrows) between left coronary artery (LCA) (yellow) and right coronary artery (purple). (B) Axial image shows contrast material from right coronary artery flowing retrograde into main pulmonary artery. This creates coronary steal phenomenon and is a small left-to-right shunt (arrow).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: Left ventricular wall motion assessment and cinematic rendering from coronary CT angiography in 80-year-old woman.Download Original Video (7.6 MB)The incidence of anomalous origin of the right coronary artery from the pulmonary artery among patients undergoing coronary CT angiography has been reported to be 0.002% (2). It is rare for patients with anomalous origin of the right coronary artery from the pulmonary artery to survive asymptomatically for 80 years without surgical intervention (2,3).Disclosures of Conflicts of Interest: S.P. disclosed no relevant relationships. H.L. disclosed no relevant relationships.References1. Mintz GS, Iskandrian AS, Bemis CE, Mundth ED, Owens JS. Myocardial ischemia in anomalous origin of the right coronary artery from the pulmonary trunk. Proof of a coronary steal. Am J Cardiol 1983;51(3):610–612. Crossref, Medline, Google Scholar2. Guenther TM, Sherazee EA, Wisneski AD, Gustafson JD, Wozniak CJ, Raff GW. Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery: A Systematic Review. Ann Thorac Surg 2020;110(3):1063–1071. Crossref, Medline, Google Scholar3. Petersen JA, Karlo CA, Alkadhi H, Gaemperli O, Biaggi P. Anomalous origin of the right coronary artery from the pulmonary artery: a rare finding in an asymptomatic man. Eur J Echocardiogr 2011;12(11):884. Crossref, Medline, Google ScholarArticle HistoryReceived: May 10 2021Revision requested: May 28 2021Revision received: May 29 2021Accepted: June 15 2021Published online: Sept 28 2021Published in print: Dec 2021 FiguresReferencesRelatedDetailsCited ByAnesthesia Consideration for a Patient With Incidentally Diagnosed Anomalous Origin of Right Coronary Artery Originating From Pulmonary Trunk (ARCAPA): A Case StudyDylan SIrvine, KristinaRozava, AlexanderTheodotou, RaymondEvans, JeffreyHuang2022 | CureusRecommended Articles Anomalous Coronary Arteries That Need Intervention: Review of Pre- and Postoperative Imaging AppearancesRadioGraphics2017Volume: 37Issue: 3pp. 740-757Congenital Coronary Artery–to–Pulmonary Artery Fistula with Anomalous Origin of Right Coronary Artery from Pulmonary Artery: A Case of “Double Trouble”Radiology: Cardiothoracic Imaging2021Volume: 3Issue: 4Left Circumflex Coronary Artery–to–Coronary Sinus Fistula with Coronary Sinus Ostial Atresia and a Persistent Left Superior Vena Cava in an Adult PatientRadiology: Cardiothoracic Imaging2022Volume: 4Issue: 1Role of CT in the Pre- and Postoperative Assessment of Conotruncal AnomaliesRadiology: Cardiothoracic Imaging2022Volume: 4Issue: 3Adult-type Anomalous Origin of the Left Coronary Artery from the Pulmonary ArteryRadiology2021Volume: 300Issue: 2pp. 287See More RSNA Education Exhibits Rarest Of The Rare: Institutional Case-based Presentation Of Unusual Coronary Artery Anomalies Using 3D-Cinematic RenderingsDigital Posters2021Transposition of Great Arteries from A to Z: Hemodynamics, Imaging, and ManagementDigital Posters2019Out on the Road: Revisiting Coronary Artery AnomaliesDigital Posters2022 RSNA Case Collection Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA)RSNA Case Collection2020Pulmonary AtresiaRSNA Case Collection2022Anomalous origin of the right coronary artery from the left sinus of ValsalvaRSNA Case Collection2020 Vol. 301, No. 3 Metrics Altmetric Score PDF download