A Case Report of Aberrant Origin of the Right Coronary Artery from the Pulmonary Artery in an Adult Male: The Role of Multi-modality Imaging

Background: The normal anatomy of the coronary arteries consists of the right coronary artery and the left main coronary artery, which originate from the right and left sinuses of Valsalva in the aortic root separately. In general, congenital anomalies of the coronary artery are uncommon in adults. The ectopic origin of a coronary artery from the pulmonary trunk is part of a group of infrequent coronary artery anomalies. The Anomalous origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) is thought to be an extremely rare congenital coronary artery anomaly. Most of our knowledge and experience about this congenital coronary malformation is derived from published case reports and series. Case Presentation: We have, herein, reported the case of a 68-year-old male who was discovered to have ARCAPA after he presented to our center with chest pain. The patient underwent multiple invasive and non-invasive diagnostic imaging modalities, including an echocardiogram, a coronary angiogram, a multislice-gated coronary computed tomographic angiogram, and stress perfusion cardiovascular magnetic resonance imaging. The clinical decision was to continue with conservative non-surgical management along with close follow-up. Conclusion: The ARCAPA anomaly is considered to be one of the rare congenital coronary artery variances that can be discovered in late adulthood as a patient may remain asymptomatic for many decades.