Coronary anomaly: anomalous right coronary artery originates from the left sinus of Valsalva and coursing between the pulmonary artery and aorta
A 60-year-old woman presented with dyspnea after physical exertion for more than 2 months. Electrocardiogram showed ST depression in inferior leads II, III, aVF. Coronary angiogram was performed through trans-femoral approach. Coronary angiogram demonstrated the LMCA was normal, there was borderline narrowing in the proximal segment of LAD, and the LCX was small and patent. Repeated attempts to cannulate the RCA were successful and the result showed that the anomalous RCA originated from the left sinus of Valsalva and there was severe narrowing in the posterior descending coronary artery (PDA). Reconstructed three-dimensional images were performed to verify the course of the anomalous RCA. The results showed the anomalous RCA originating from the left sinus anterior to the left coronary artery ostium, then taking an acute bend to course between the aorta and pulmonary artery. The right coronary artery anomaly was classified as type L-II B subtype ( and ). Neither percutaneous coronary intervention (PCI) nor coronary artery bypass grafting (CABG) was performed, and the patient was only treated medically.