Transcatheter Closure of Congenital RCA-Replacing Aorto–Right Ventricular Tunnel

BACKGROUND: Aorto-right ventricular tunnels are rare congenital anomalies. Complete replacement of the right coronary artery (RCA) by such a tunnel is exceptionally uncommon. CASE SUMMARY: A 58-year-old woman presented with progressive dyspnea. Echocardiography showed left ventricular dilatation and reduced systolic function. Computed tomography angiography demonstrated the absence of a native RCA ostium and a large tunnel arising from the right coronary sinus, following the expected RCA course and draining into the right ventricle. The distal right coronary territory was supplied by the left anterior descending artery collaterals. Transcatheter closure was performed via a retrograde transaortic approach using a 14/12-mm ventricular septal defect occluder, achieving complete tunnel exclusion without compromising coronary perfusion. DISCUSSION: To our knowledge, this is a rare transcatheter closure of a congenital RCA-replacing aorto-right ventricular tunnel and supports further evaluation of this proposed procedural strategy. Because this is a single-case experience, the approach is considered hypothesis-generating rather than validated.