A High Take-Off Right Coronary Artery with Intramural Course: A Rare Case Review

Abstract

Introduction: Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital condition (prevalence 0.1%–0.33%) frequently associated with sudden cardiac death in young populations. While a "high take-off" (origin >1 cm above the sinotubular junction) is often incidentally found and considered benign, its clinical significance increases when paired with high-risk features like an intramural course or slit-like ostium.

Case Presentation: We present the case of an asymptomatic 60-year-old male whose routine evaluation via Coronary Computed Tomography Angiography (CCTA) revealed a high take-off of the right coronary artery (RCA). The ostium was located 11 mm above the right sino-tubular junction, exhibiting an elliptical, slit-like morphology and an acute take-off angle. Uniquely, the RCA followed a prolonged 14-mm intramural course within the aortic wall, though notably absent of a "malignant" interarterial path between the aorta and pulmonary artery.

Conclusion: The presence of a significant intramural course does not necessitates surgery in all patients. In the absence of an interarterial course and clinical symptoms, particularly in patients over age 35, conservative medical management and rigorous surveillance provide a safe alternative to high-risk surgical correction.