Anomalous right coronary artery stemming
from left coronary sinus and malignant
interarterial course in a middle-aged woman:
a case report and review of diagnostic
and surgical management

Anomalous right coronary artery stemming
from left coronary sinus and malignant
interarterial course in a middle-aged woman:
a case report and review of diagnostic
and surgical management

Coronary artery anomalies, Coronary artery bypass, Coronary angiography, Myocardial ischemia,
Tomography, X-ray computed

Abstract
Background An anomalous right coronary artery (RCA) arising from the left coronary sinus with an interarterial/
intramural course can cause exertional ischemia and, rarely, sudden death. Functional testing and coronary CT
angiography (CCTA) are key for diagnosis and risk stratification.
Case presentation We report the case of a 46-year-old woman presenting with exertional dyspnea and jaw
discomfort. She had no conventional cardiovascular risk factors aside from hyperlipidemia and a family history of
premature coronary disease. Exercise treadmill testing and myocardial perfusion imaging revealed inducible ischemia.
Coronary computed tomography angiography demonstrated an anomalous RCA arising from the left coronary sinus
with an interarterial and intramural course between the aorta and pulmonary artery. Surgical consultation confirmed
a malignant anatomical variant, and the patient underwent successful coronary artery bypass grafting (CABG) with
complete symptom resolution.
Discussion This case underscores the importance of considering congenital coronary anomalies in the differential
diagnosis of exertional angina, especially in patients without atherosclerosis or major cardiovascular risk factors.

Functional and anatomical imaging are essential for risk stratification. CABG remains an effective treatment for high-
risk anomalies when direct reimplantation is not feasible.

Conclusion In symptomatic patients with demonstrable ischemia and high-risk anatomic features, surgery provides
excellent outcomes. Early recognition using complementary functional and anatomic imaging is essential.

Arya Khezrpour1

, Mehran Abdollahi2*, Pouya Ebrahimi3*, Amin Zaki Zadeh4

, Nazanin Rafiei5

, Sara Montazeri Namin6
,

Pedram Ramezani1

, Touba Akbari7

and Mohammad Hossein Mandegar8

https://doi.org/10.1186/s12245-025-01042-8

2025

Peri Irawan

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