Anomalous right coronary artery from the left sinus of Valsalva presenting a challenge for percutaneous coronary intervention

In a case of anomalous right coronary artery (RCA) origin form the left aortic sinus with interarterial course and concomitant obstructive atherosclerosis that has been presented in the January 2009 issue of Archives of the Turkish Society of Cardiology the patient underwent successful percutaneous coronary intervention to the atherosclerotic lesions. Aberrant RCA coursing and its potential to lead to ischemia was presumably managed in a conservative way. Anomalous coronary artery origin from the opposite aortic sinus with interarterial course is considered as the anomaly with the greatest potential for an adverse outcome. In such cases the culprit mechanism that leads to ischemic sequelae has been shown to be related to the proximal ectopic vessel that always travels an intramural course. Revealing the degree of proximal impediment both at rest and exercise-like conditions with intracoronary ultrasound examination has been shown to provide useful information regarding patient management. This report presents some comments on the aforementioned case highlighting the role of such an invasive assessment on patient management.