Survival post out-of-hospital cardiac arrest from anomalous right coronary artery: A case report and insight into management

Anomalous coronary arteries originating from the opposite sinus of Valsalva are rare causes of sudden cardiac death (SCD), and when present are associated with poor outcomes. We present a rare case of a young man with an anomalous right coronary artery (RCA) presenting with out of hospital cardiac arrest and provide insights into management. A 27-year-old healthy Chinese man presented with out of hospital cardiac arrest during exertion, with initial electrocardiogram and echocardiography unrevealing for an underlying cause of collapse. Subsequent computed tomography coronary angiogram revealed the presence of an anomalous origin of the RCA from the left coronary sinus with acute angle take-off and slit-like orifice, with an inter-arterial course. Other investigations, including flecainide challenge test, cardiac magnetic resonance imaging, and treadmill stress tests were unyielding. He subsequently underwent an uneventful surgery to unroof the origin of the anomalous RCA without the need for an implantable cardiac defibrillator. The patient made a full recovery post-surgery and was discharged well. Anomalous coronary arteries with an inter-arterial course are a rare cause of SCD and where responsible, these anomalies are often found postmortem after SCD. In our case, the patient successfully underwent surgical correction.

Learning objectives

Anomalous coronary arteries are a rare cause of cardiac arrest and when present, are often associated with poor neurological and functional outcomes. The long-term management of this group of patients is not well known. After appropriate surgical correction and with preserved cardiac function, an implantable cardiac defibrillator may not always be necessary. This decision should follow a detailed discussion between the cardiologist, cardiothoracic surgeons, and patient.