Peruničić Ana, Furtula Matija, Veljković Stefan, Lakčević Jovana, Šljivo Armin, Balint Valentina, Tomić Slobodan, Vučinić Sanja, Bojić Milovan, Nikolić Aleksandra
Cardiovascular Institute "Dedinje'', 11040 Belgrade, Serbia.
Department for Cardiosurgery, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
Life (Basel). 2025 May 1;15(5):736. doi: 10.3390/life15050736.
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly, with an uncertain prevalence and often diagnosed incidentally. This case report presents a 62-year-old male with ARCAPA diagnosed during an evaluation for chest surgery. The patient had a history of colon cancer and active tuberculosis, complicating the clinical management. He reported chest pain, shortness of breath, and palpitations, with atrial fibrillation observed on a 24 h Holter ECG. Coronary angiography revealed robust collateral circulation and a suspected anomalous origin of the right coronary artery, confirmed by CT imaging. The patient's stress MRI showed mildly reduced left and right ventricular ejection fractions and perfusion deficits in the apical segments (2/17) of the septal and inferior walls. Given the patient's comorbidities, including active tuberculosis, the Heart team decided on a non-operative management approach, focusing on careful monitoring and pharmacological management rather than immediate surgery. This case emphasizes the complexity of managing ARCAPA in the context of significant comorbidities, highlighting the importance of individualized, multidisciplinary treatment strategies. Early diagnosis using advanced imaging techniques is crucial, and a non-operative approach can be considered in patients with preserved left ventricular function and no significant ischemia, as demonstrated in this case.
右冠状动脉起源于肺动脉（ARCAPA）是一种罕见的先天性冠状动脉异常，患病率尚不确定，且常为偶然诊断。本病例报告介绍了一名62岁男性，在胸部手术评估期间被诊断为ARCAPA。该患者有结肠癌和活动性肺结核病史，使临床管理复杂化。他报告有胸痛、气短和心悸症状，24小时动态心电图监测发现房颤。冠状动脉造影显示有丰富的侧支循环，右冠状动脉疑似起源异常，CT成像予以证实。患者的负荷磁共振成像显示左、右心室射血分数轻度降低，室间隔和下壁心尖段（2/17）存在灌注缺损。鉴于患者存在包括活动性肺结核在内的合并症，心脏团队决定采取非手术治疗方法，重点是密切监测和药物治疗，而非立即手术。本病例强调了在存在严重合并症的情况下管理ARCAPA的复杂性，突出了个体化多学科治疗策略的重要性。如本病例所示，使用先进成像技术进行早期诊断至关重要，对于左心室功能保留且无明显缺血的患者可考虑采取非手术方法。
