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Case Studies | Cardiology Science | India | Volume 12 Issue 8, August 2023 | Rating: 5.4 / 10
Anomalous Origin of Right Coronary Artery Originating from the Pulmonary Trunk (ARCAPA): A Rare Incidental Finding in a Patient with Chest Pain at a Tertiary Care Hospital in Rajasthan
Dr. Manas Thakur | Dr. Ramanand P. Sinha
Abstract: Anomalous origin of the right coronary artery originating from the pulmonary trunk (ARCAPA) is a rare congenital coronary anomaly. Mostly the patients are symptoms free and this anomaly is an incidental finding during evaluation for other problems. We present a case of a 53years male with no known comorbidities, presenting to the emergency department with intermittent chest pain and heaviness for three days. The initial electrocardiogram (ECG) demonstrated sinus tachycardia with q waves in inferior leads. Echocardiography was suggestive of fair ejection fraction. He underwent coronary angiography that was not associated with any stenosis. Contrast reflux was seen from the right coronary artery (RCA) ostium to the pulmonary artery along with retrograde filling of the RCA. There was no any significant obstruction of the RCA when it was traced via left to right collaterals. Right heart catheterization and pulmonary angiography were performed which confirmed the origin of the RCA from the pulmonary trunk. The patient was kept on medical management for the time being and was advised for surgery. Later he was discharged home with slight improvement in his symptoms. Origin of the RCA from the pulmonary artery (ARCAPA) is a rare congenital malformation. Most of the patients with ARCAPA remain asymptomatic. In this case report, the chest discomfort was probably unrelated to the coronary malformation. However, sudden cardiac death may have been linked to ARCAPA (if associated with Myocardial Infarction) and therefore a corrective surgical procedure is recommended even for the patients who are symptoms free. Surgical techniques which are available include: (a) Simple ligation of the RCA (b) Ligation of the RCA with saphenous vein bypass grafting and re - implantation of the RCA into the aorta (this method is considered to be better for the restoration of blood supply in myocardium). However, its long - term benefits have not been conclusively demonstrated.
Keywords: ARCAPA, coronary anomaly, chest pain, pulmonary trunk, surgical techniques
Edition: Volume 12 Issue 8, August 2023,
Pages: 477 - 479