J Korean Soc Radiol.  2010 Feb;62(2):113-117. 10.3348/jksr.2010.62.2.113.

The Noninvasive Diagnosis and Postoperative Evaluation of Anomalous Right Coronary Artery from the Pulmonary Artery (ARCAPA) using Coronary MDCT: A Case Report

• Lim JH
• Choi S
• Kang YJ
• Seon HJ
• Kim YH

• KMID: 2208947
• DOI: http://doi.org/10.3348/jksr.2010.62.2.113

Abstract

A 63-year-old man was admitted with complaints of exertional dyspnea and atypical chest pain. Coronary angiography and 64-slice multidetector computed tomography (MDCT) revealed an anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). He received a coronary artery bypass graft (CABG). The incidence of ARCAPA is extremely rare. We report here on the first case of ARCAPA that was noninvasively diagnosed and postoperatively followed up with 64-slice MDCT.

MeSH Terms

Chest Pain
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Disease
Coronary Vessel Anomalies
Coronary Vessels
Dyspnea
Humans
Incidence
Middle Aged
Multidetector Computed Tomography
Pulmonary Artery
Tomography, X-Ray Computed
Transplants

Figure

• 

  Fig. 1 The aortogram shows a single coronary sinus (arrow) and only opacification of the left coronary artery (A, B). The late phase left coronary angiogram (C) demonstrates retrograde filling of the right coronary artery (RCA, arrow) into the pulmonary trunk from multiple rich collaterals (arrow heads) from the left coronary artery.

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  Fig. 2 The curved multiplanar reformatted (MPR) image (A) and volume rendered (VR) image (B) demonstrate the anomalous origin of the RCA (arrows) from the pulmonary trunk. Rich collaterals (arrow heads) from the left coronary artery existed at the interventricular septum on the short axis two chamber view (C) and the inferior wall of the right ventricle at the level of the coronary sinus on the four chamber view (D). There is no significant stenotic narrowing or intimal calcification in the left anterior descending and circumflex arteries (not shown). * Ao: aorta, PA: pulmonary artery

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  Fig. 3 Tc-99m tetrofosmin (TF) rest/stress myocardial perfusion SPECT (MSPECT). MSPECT shows the fixed and partly reversible perfusion defect and hypokinesia in the inferior wall. We thought that myocardial ischemia and infarction occurred in the RCA territory.

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  Fig. 4 The postoperative curved MPR (A) and VR (B) images obtained after ligation of the original os of the RCA from the pulmonary trunk (arrow head) and creation of an anastomosis (arrow) between the right internal mammary artery (RIMA) and the RCA.

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