Anomalous coronary artery from the pulmonary artery diagnosed in adulthood: a case series on variations of coronary anatomy and the diagnostic value of cardiac magnetic resonance imaging

Anomalous Arising of Right Coronary Artery from the Pulmonary Artery

Coronary artery anomalies are seen in less than 1% of the general population and in 1.6% of cardiac catheterization cases. The anomalous origin of the coronary artery from the pulmonary artery is one of four groups of coronary artery origin anomalies. The incidence of anomalous origin of the right coronary artery from the pulmonary artery is 1 in 500,000 and was first described in 1882 by John Brook. This case report reports on a 67-year-old man with a diagnosis of asymptomatic anomalous origin of the right coronary artery from the pulmonary artery. The patient underwent surgery of the aortic valve because of valve stenosis. A concomitant surgical procedure included repositioning of the right coronary artery origin to the aortic root sinus. The patient was discharged on the 12th postoperative day, in good condition. Anomalous origin of the right coronary artery from the pulmonary artery is commonly asymptomatic, and surgery is required only if myocardial ischemia is presented.

Bland White Garland syndrome with aneurysm and collaterals of coronary arteries in an Afghan girl: a case report

Bland White Garland Syndrome is a very rare congenital heart defect in which the left coronary artery arises abnormally from the pulmonary artery. We present an extremely rare case of Bland White Garland Syndrome with an aneurysm of the left coronary artery in a 14-year-old Afghan girl. The patient was asymptomatic throughout her life except for one attack of exertional chest discomfort. The diagnoses of these anomalies were established by electrocardiography, echocardiography, coronary angiography, and computed tomography of the chest. During her hospital stay and on discharge, she had a stable condition and was referred for surgical management in an advanced setting abroad. Anomalous origin of the left coronary artery from the pulmonary artery may coexist with an aneurysm of the left coronary artery and not exhibit symptoms until adolescence.

Challenging Diagnosis of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

Anomalous origin of the right coronary artery (RCA) from the pulmonary artery, ARCAPA, is an extremely rare congenital heart disease. Only 200 cases were reported from 1885 to the present. Patients diagnosed with ARCAPA can be either asymptomatic or can experience symptoms, such as heart murmur, dyspnea, or angina, shortly after birth or around 40-60 years of life. Usually, those with isolated ARCAPA are diagnosed later in life compared to those who associate other structural cardiac defects. We report two cases of anomalous origin of the right coronary artery at the level of the pulmonary artery trunk (ARCAPA) that were diagnosed by invasive coronary angiography. Although asymptomatic, general recommendations suggest an early corrective intervention to prevent complications such as myocardial ischemia and cardiac dysfunction, which can lead to sudden cardiac death.