Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) unmasked by coronary artery disease of the left coronary system in a 62-year-old man.

This case is an illustration of the complex interplay between congenital coronary anomalies like anomalous right coronary artery from pulmonary artery and acquired cardiovascular conditions like coronary artery disease (CAD) in adults. Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly which is typically diagnosed in childhood or young adulthood. There is limited data on the incidence of ARCAPA in older adults, particularly in association with CAD. Development of symptoms due to onset of significant stenosis in the left coronary artery system (left anterior descending artery and left circumflex artery), led to the discovery of ARCAPA in our case. Surgical correction is considered the treatment of choice in anomalous origin of coronary artery from pulmonary artery, regardless of the age of presentation and symptom status. While several surgical techniques for managing ARCAPA have been described, the goal of surgical intervention should be to restore the dual coronary system in order to optimize outcomes.