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Echocardiogram (Figure 1A-B) in an asymptomatic 6 month-old raised suspicion for anomalous Right Coronary Artery (RCA) from the Pulmonary Artery (ARCAPA) with retrograde flow from the RCA to the main pulmonary artery. The patient’s left ventricular systolic function was normal. Subsequent cardiac catheterization confirmed the diagnosis as angiography showed that the RCA arose from the anterior aspect of the main pulmonary artery and filled retrograde via a collateral network from the Left Coronary Artery (LCA) system (Figure 1C-D). At 10 months of age, the patient underwent surgical translocation of the RCA to the aorta. On direct visualization, the RCA arose from the anterior wall of the main pulmonary artery and the robust collateral supply of the RCA from the LCA was visualized on the heart’s epicardium (Figure 2). The patient did well and was discharged home several days later. Three months after the operation, the patient continues to do well with normal left ventricular systolic flow and prograde flow into the reimplanted RCA.

Successful repair of an anomalous right coronary artery arising from the pulmonary artery in a 10 month-old