Presentation
Occasional shortness of breath.
Patient Data
The right coronary artery arises anomalously from the main pulmonary artery. The left coronary artery arises normally from the aorta. The coronaries have a normal course, but both are markedly dilated and tortuous, likely secondary to left to right collaterals. Contrast flows from the right coronary artery into the pulmonary artery indicating a left to right shunt. There is RCA dominance.
Case Discussion
Anomalous origin of the right coronary artery from the pulmonary artery is known as ARCAPA. The RCA is perfused retrograde from left coronary collaterals with flow of blood into the pulmonary artery, resulting in a left to right shunt. Both the left and right coronaries tend to dilate and have a tortuous course.
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