Anomalous origin of the right coronary artery from the opposite sinus with interarterial course: A case report

An anomalous origin of the right coronary artery from the opposite sinus (R- ACAOS) with interarterial course is a very rare congenital anomaly with an increased risk of sudden cardiac death. A 29-year-old woman was admitted for exertional angina pectoris. A coronary computed tomography angiography with 3D multiplanar reconstruction revealed an R-ACAOS running between the aorta and pulmonary artery with high anatomical features and no ischemia-induced at the stress test. The heart team staff decided to manage the patient surgically. Coronary arteries are characterized by their origin, course, and boundaries with intracardiac structures and large vessels. Computed tomography angiography is the gold standard exam to confirm the diagnosis and identify high-risk anatomic features that guide the management. It is important to consider treatment options for these patients whether by medical treatment, coronary angioplasty, or surgical repair, because of the increased risk of SCD. We hereby present an R-ACAOS with interarterial course and high anatomic features, which is an uncommon finding and can be fatal if it remains undiscovered.