Malignant interarterial course of the right coronary artery

Case contributed by Craig Hacking


Chest pain. Risk factors for coronary artery disease. Equivocal stress echo.

Patient Data

Age: 65 years
Gender: Male

Malignant course of the right coronary artery which arises from the left coronary cusp, passing at acute angle to the right between the pulmonary trunk and ascending aorta. This is causing significant proximal vessel narrowing by extrinsic compression.

Non calcified plaque in the mid left anterior descending artery is causing only mild stenosis. No other coronary artery disease.

Case Discussion

Due to the aberrant origin from the left coronary sinus, the origin is 'slit like' and the proximal vessel is narrowed due to extrinsic compression between the ascending aorta and pulmonary trunk, both of which can lead myocardial ischemia in the right coronary artery territory.

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