A Rare Case of Undiagnosed Anomalous Right Coronary Artery From the Pulmonary Artery in an Asymptomatic Seven-Year-Old

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is an extremely rare congenital coronary artery anomaly. Diagnosis is often made incidentally when evaluating for a murmur or other congenital heart disease. The ARCAPA may present with right heart failure and/or sudden cardiac death and surgical repair is recommended once the diagnosis is made. A seven-year-old child previously diagnosed with small ventricular septal defects presented to our cardiology clinic as a new patient. Echocardiogram revealed suspicion of a coronary anomaly and computed tomography angiography (CTA) confirmed a diagnosis of ARCAPA. She underwent successful surgical reimplantation of the anomalous right coronary artery and made an excellent recovery. This case highlights the importance of maintaining a high index of suspicion for coronary anomalies and strongly considering CTA in patients with imaging findings or symptoms consistent with ARCAPA.