title: Anomalous origin of the right coronary artery evaluated with multidetector computed tomography and its clinical relevance.
abstract: Anomalous origin of the right coronary artery (AORCA) is a rare congenital anomaly that may cause myocardial ischemia and sudden death.
  
  
  
  We reviewed the clinicopathological records of three cases of AORCA, and compared these with two cases of sudden cardiac death with AORCA revealed by autopsy.
  
  
  
  We report three juvenile cases with an AORCA originating above the commissural junction between the left and right aortic sinuses, with interarterial and intramural compression. They presented with exertional symptoms and were diagnosed with an AORCA by multidetector computed tomography (MDCT), which successfully delineated the spatial resolution of the anomalous origin and course of the right coronary artery (RCA), in the operating room. All three underwent successful surgical unroofing of the RCA. Two cases of sudden cardiac death with AORCA revealed by autopsy showed a slit-like orifice, acute-angled take-off, and long intramural course of the RCA, resembling the RCAs of three juvenile cases.
  
  
  
  It is crucial to be alert to the presentation of exertional symptoms, as sudden death may be the first manifestation of an anomalous coronary artery, such as those observed in these three cases. MDCT provided an excellent definition and spatial resolution of the unusual origin and intramural course of the RCA, facilitating the correct surgical remedy and resulting in a good outcome for the patients.
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hirono
authors.affiliation: Department of Legal Medicine, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Hata
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Naruaki
authors.initials: N
authors.lastname: Miyao
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nakaoka
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Ibuki
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Ozawa
authors.affiliation: First Department of Surgery, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Higuma
authors.affiliation: First Department of Surgery, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimura
authors.affiliation: Department of Legal Medicine, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nishida
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama City, Toyama, Japan. Electronic address: fukiko@med.u-toyama.ac.jp.
authors.forename: Fukiko
authors.initials: F
authors.lastname: Ichida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D005082:Physical Exertion / Q000502:physiology; D013575:Syncope / Q000503:physiopathology
keywords: Anomalous origin of the right coronary artery; Multidetector computed tomography; Right coronary artery; Sudden cardiac death