High anomalous origin of the right coronary artery associated with aortic stenosis: a word of caution.

We report a case with rare anomalous origins of the right coronary artery that arises from the ascending aorta. An 82-year-old woman scheduled for aortic valve replacement for severe aortic stenosis was incidentally found to have an unusual origin of the right coronary artery during routine screening for coronary artery disease by preoperative 64-slice multi-detector row computed tomographic angiography. The artery originated from the left surface of the ascending aorta approximately 2 cm above the sinotubular junction, where the transverse aortotomy is routinely placed. This detection resulted in avoidance of an intraoperative interruption of the right coronary artery. A preoperative multi-detector row computed tomography angiographic scan was very useful not only for evaluation of the coronary artery disease, but also for detection of a rare anomalous origin of the right coronary artery. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.