Presentation
Dyspnea.
Patient Data
The right coronary artery arises from the pulmonary artery, the anomalous RCA origin is well shown on the 3D reconstruction. The left coronary artery arises normally from the aorta. Both coronary arteries are dilated, with no obstructive lesions.
Left coronary artery injection opacifies first the left coronary artery, then the right coronary artery with eventual opacification of the pulmonary artery indicating a left to right shunt.
Diagrammatic comparison of normal and abnormal RCA origins. A diagram of anomalous left coronary artery from the pulmonary artery (ALPACA) is included for comparison.
Case Discussion
This case illustrates the findings of ARCAPA (Anomalous Origin of Right Coronary Artery from Pulmonary Artery). Collaterals develop from the left to the right coronary artery, with retrograde flow from the right coronary artery into the pulmonary artery, resulting in dilation of both the left and right coronaries.
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