Combination of Unroofing and Relocation to Treat Anomalous Origin of the Right Coronary Artery

Background: Anomalous aortic origin of the right coronary artery (AAORCA) from the left sinus of Valsalva is a rare congenital condition that can lead to severe complications such as sudden cardiac death, especially in active individuals. Case Summary: A 55-year-old woman presented with worsening palpitations, chest pain, and elevated troponin levels. AAORCA was eventually diagnosed. Her right coronary artery (RCA) origin was in close proximity to the orifice of the left main coronary artery, and the RCA itself had a short intramural course. She underwent surgery that involved the combination of both unroofing and relocation of the RCA. Discussion: There are no guidelines providing a clear path for the surgical resolution of AAORCA. Our case highlights the need for a tailored surgical approach for each individual case that adapts to the specific anatomical variation of the patient and dynamically addresses intraprocedural discoveries not visible on preoperative imaging. Take-Home Messages: Surgery for AAORCA needs to be tailored to each patient, as important details often are discerned only during the operation. A combination of surgical techniques may be needed to treat the artery safely and fully. Computed tomography angiography is crucial for planning, especially when standard tests cannot clearly show the abnormal artery.