All in One: Anomalous Coronary Arteries Arising from the Right Cusp

Background: Coronary artery anomaly (CAA) refers to structural abnormalities affecting the coronary arteries and, in most cases, are rare congenital defects affecting almost 1% of the general population. These malformations can vary in presentation, ranging from benign variations to potentially life-threatening anomalies. Anomalous coronary arteries arising exclusively from the right coronary cusp (RCC) represent a rare occurrence with an estimated incidence of approximately 0.03-0.2% in the general population. Case Report: We are presenting a case of a 73-year-old male with a past medical history of coronary artery disease with prior coronary artery bypass surgery who came to the emergency department with chest pain. Given his ongoing symptoms, he was taken urgently to the Cardiac Cath Lab. He was found to have anomalous coronary arteries, all arising from the right coronary cusp. He has a chronic total occlusion of the right coronary artery (RCA) at the proximal segment with the faint right to right collaterals coming from the RV branch, 100% circumflex occlusion, with the left anterior descending artery (LAD) coming off from the proximal RCA that was diffusely diseased but patent, he had an antegrade filling and competitive flow from the left internal mammary artery (LIMA). Conclusion: Understanding this anomaly's anatomical variations and potential hemodynamic consequences is crucial for accurate diagnosis, appropriate management, and optimizing patient outcomes. Management strategies for coronary artery malformation depend on the specific anatomical and functional characteristics and the presence or absence of symptoms. Treatment options may include medical management, lifestyle modifications, interventional procedures, or surgical intervention.