A Rare Anomalous Origin of the Right Coronary Artery From Mid-Left Anterior Descending Artery: Do Not Rush Into Action.

BACKGROUND

Coronary artery anomalies represent the second leading cause of sudden cardiac death among young athletes, with limited evidence for the management of symptomatic individuals.

CASE SUMMARY: We present a case of a single coronary artery anomaly; the right coronary artery (RCA) originating from the mid-left anterior descending artery (LAD). Further evaluation with stress imaging showed no evidence of stress-induced ischemia.

DISCUSSION: This represents a rare case of an anomalous origin and course of the RCA from the mid-LAD with a malignant interarterial course. The initial diagnosis was an ostial RCA chronic total occlusion with presumed retrograde filling from the LAD. However, a careful review of the angiogram demonstrated antegrade rather than retrograde flow. The diagnostic uncertainty was ultimately resolved by computed tomography coronary angiography.

TAKE-HOME MESSAGE: In case of suspected coronary anomalies or an unclear coronary course and/or origin, a computed tomography angiography is strongly recommended.