Right coronary artery arising from the main pulmonary artery: evaluation with 2-dimensional transthoracic echocardiography and multislice computed tomography.

A 30-year-old man was admitted to our hospital with incidental chest pain. Two-dimensional transthoracic echocardiography revealed a dilated vessel in front of the aorta. Color-f low Doppler echocardiographic imaging showed a retrograde, chief ly diastolic f low from near the pulmonary valve into the main pulmonary artery (Fig. 1) and adequate intercoronary collateral vessels within the ventricular septum, anterior wall, and inferior wall. The origin of the right coronary artery (RCA) was not visible from the right sinus of Valsalva. The configuration of the RCA appeared to be anomalous. On the basis of the echocardiographic findings, the diagnosis of anomalous origin of the right coronary artery from the main pulmonary artery (ARCAPA) was made. Subsequent 64-multislice computed tomographic 3-dimensional reconstruction imaging of the coronary arteries confirmed the echocardiographic diagnosis, and 3-dimensional computed tomographic volumerendered reformation showed only a single large left coronary artery that arose from the ascending aorta. The left anterior descending coronary artery was noticeably dilated and particularly tortuous (Fig. 2). An enlarged and tortuous RCA originated at the main pulmonary artery and coursed in front of the aorta (Fig. 3), and there was a Images in Cardiovascular Medicine