Anomalous Right Coronary Artery Arising from Pulmonary Artery in a Woman with Ventricular Dysfunction

A 56-year-old multiparous woman presented with chest pain, palpitations, and worsening dyspnea on exertion. She had a history of substance abuse. A systolic ejection murmur was audible at the left sternal border. Laboratory f indings were normal. An electrocardiogram revealed sinus rhythm with left ventricular (LV) hypertrophy. A transthoracic echocardiogram showed right ventricular hypertrophy, normal right ventricular systolic function, and moderately depressed LV systolic function (ejection fraction, 0.35–0.40). Anomalous flow arising from the pulmonary artery (PA) was noted in color-flow Doppler mode (Fig. 1). A cardiac computed tomographic angiogram revealed an anomalous right coronary artery from the PA (ARCAPA) with dilated epicardial coronary arteries and prominent left-to-right collateral vessels (Fig. 2). The patient was started on medical therapy for LV dysfunction. It was thought that ARCAPA was contributing to the development of heart failure, so she was referred for surgical reimplantation of the right coronary artery to the aorta. However, she was lost to follow-up and, to our knowledge, never proceeded with surgical correction. Images in Cardiovascular Medicine