ANOMALOUS ORIGIN OF THE RIGHT CORONARY-ARTERY FROM THE PULMONARY-ARTERY IN ASSOCIATION WITH A VENTRICULAR SEPTAL-DEFECT

Origin of the right coronary artery from the pulmonary artery is a rar e lesion occasionally found at angiography or autopsy. We report the r are preoperative diagnosis, in a child of anomalous origin of the righ t coronary artery from the pulmonary artery in association with a vent ricular septal defect. The chest radiograph was normal, but auscultati on revealed a continuous murmur at the left sternal border and electro cardiography showed right and left ventricular hypertrophy. A transtho racic echocardiogram depicted anomalous origin of the right coronary a rtery from the pulmonary artery. Color-flow Doppler echocardiography i ndica ted possible right-coronary-artery-to-right-ventricle fistulae. Diagnosis was made by selective left coronary arteriography, which sho wed retrograde filling of the right coronary artery from collateral ve ssels. Selective left coronary arteriography depicted intercoronary fl ow with no fistulae. Operative repair consisted of moving the proximal right coronary artery from its origin at the pulmonary trunk to the a orta. An associated procedure for correction of the ventricular septal defect was performed The postoperative cardiac angiogram showed that the ventricular septal defect was closed and that flow through the rig ht coronary artery was normal. Preoperative diagnosis of anomalous ori gin of the right coronary artery from the pulmonary artery is importan t, because this condition is surgically correctable.