Our hypothetical patient is a 30 year old male construction worker who complained of chest pains at rest, had inferior ST depression and elevated troponin. He settled with medical therapy.
X-ray angiography revealed smooth coronaries without atherosclerosis, but an aberrant RCA.
Subsequent cardiac CT revealed RCA arising from the left coronary sinus of the aorta, but with a separate origin to the left main artery (Image 1). The RCA course was between the ascending aorta and the pulmonary artery. initially the calibre was small (Image 2), widening out once it was in the 'normal' position (Image 3).
The working diagnosis was inferior NSTEMI secondary to compression of the RCA.
What are your views on therapy for this patient?
Is surgery needed? If so, which operation ? Re-implantation of the RCA, or bypass of the RCA?
Is there a role for stenting of the segment lying between PA and Aorta?
Let us know your opinions on how to manage these rare but important patients.
