Posterior root enlargement for aortic valve replacement associated with unexpected anomalous right coronary artery.

Anomalous right coronary artery (ARCA) generally follows a course between the aorta and pulmonary artery. When ARCA follows a course posterolateral to the aortic root behind the noncoronary sinus of Valsalva, the vessel can be at risk of injury during posterior aortic root enlargement. We present the case of a 21-year-old man with congenital aortic stenosis and small aortic root, who had an intraoperative diagnosis of ARCA. After posterior root enlargement through the noncoronary sinus, ARCA was mobilized from the aortic root and reimplanted into the right coronary sinus. Postoperative follow-up of the patient was uneventful.