Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management Challenge
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly, with an uncertain prevalence and often diagnosed incidentally. This case report presents a 62-year-old male with ARCAPA diagnosed during an evaluation for chest surgery. The patien...
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MDPI AG
2025-05-01
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| author | Ana Peruničić Matija Furtula Stefan Veljković Jovana Lakčević Armin Šljivo Valentina Balint Slobodan Tomić Sanja Vučinić Milovan Bojić Aleksandra Nikolić |
| author_facet | Ana Peruničić Matija Furtula Stefan Veljković Jovana Lakčević Armin Šljivo Valentina Balint Slobodan Tomić Sanja Vučinić Milovan Bojić Aleksandra Nikolić |
| author_sort | Ana Peruničić |
| collection | DOAJ |
| description | Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly, with an uncertain prevalence and often diagnosed incidentally. This case report presents a 62-year-old male with ARCAPA diagnosed during an evaluation for chest surgery. The patient had a history of colon cancer and active tuberculosis, complicating the clinical management. He reported chest pain, shortness of breath, and palpitations, with atrial fibrillation observed on a 24 h Holter ECG. Coronary angiography revealed robust collateral circulation and a suspected anomalous origin of the right coronary artery, confirmed by CT imaging. The patient’s stress MRI showed mildly reduced left and right ventricular ejection fractions and perfusion deficits in the apical segments (2/17) of the septal and inferior walls. Given the patient’s comorbidities, including active tuberculosis, the Heart team decided on a non-operative management approach, focusing on careful monitoring and pharmacological management rather than immediate surgery. This case emphasizes the complexity of managing ARCAPA in the context of significant comorbidities, highlighting the importance of individualized, multidisciplinary treatment strategies. Early diagnosis using advanced imaging techniques is crucial, and a non-operative approach can be considered in patients with preserved left ventricular function and no significant ischemia, as demonstrated in this case. |
| format | Article |
| id | doaj-art-ab795319d2dd46be8eef9e05a339b984 |
| institution | OA Journals |
| issn | 2075-1729 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj-art-ab795319d2dd46be8eef9e05a339b9842025-08-20T01:56:16ZengMDPI AGLife2075-17292025-05-0115573610.3390/life15050736Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management ChallengeAna Peruničić0Matija Furtula1Stefan Veljković2Jovana Lakčević3Armin Šljivo4Valentina Balint5Slobodan Tomić6Sanja Vučinić7Milovan Bojić8Aleksandra Nikolić9Cardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaCardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaCardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaCardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaDepartment for Cardiosurgery, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and HerzegovinaCardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaCardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaCardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaCardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaCardiovascular Institute “Dedinje’’, 11040 Belgrade, SerbiaAnomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly, with an uncertain prevalence and often diagnosed incidentally. This case report presents a 62-year-old male with ARCAPA diagnosed during an evaluation for chest surgery. The patient had a history of colon cancer and active tuberculosis, complicating the clinical management. He reported chest pain, shortness of breath, and palpitations, with atrial fibrillation observed on a 24 h Holter ECG. Coronary angiography revealed robust collateral circulation and a suspected anomalous origin of the right coronary artery, confirmed by CT imaging. The patient’s stress MRI showed mildly reduced left and right ventricular ejection fractions and perfusion deficits in the apical segments (2/17) of the septal and inferior walls. Given the patient’s comorbidities, including active tuberculosis, the Heart team decided on a non-operative management approach, focusing on careful monitoring and pharmacological management rather than immediate surgery. This case emphasizes the complexity of managing ARCAPA in the context of significant comorbidities, highlighting the importance of individualized, multidisciplinary treatment strategies. Early diagnosis using advanced imaging techniques is crucial, and a non-operative approach can be considered in patients with preserved left ventricular function and no significant ischemia, as demonstrated in this case.https://www.mdpi.com/2075-1729/15/5/736ARCAPAanomalous coronary arterytuberculosiscoronary angiographystress MRIconservative treatment |
| spellingShingle | Ana Peruničić Matija Furtula Stefan Veljković Jovana Lakčević Armin Šljivo Valentina Balint Slobodan Tomić Sanja Vučinić Milovan Bojić Aleksandra Nikolić Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management Challenge Life ARCAPA anomalous coronary artery tuberculosis coronary angiography stress MRI conservative treatment |
| title | Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management Challenge |
| title_full | Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management Challenge |
| title_fullStr | Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management Challenge |
| title_full_unstemmed | Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management Challenge |
| title_short | Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management Challenge |
| title_sort | anomalous right coronary artery in the setting of active tuberculosis a multidisciplinary management challenge |
| topic | ARCAPA anomalous coronary artery tuberculosis coronary angiography stress MRI conservative treatment |
| url | https://www.mdpi.com/2075-1729/15/5/736 |
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