[HSF] Anomalous RCA

[Dan Waters]

I am seeing a 30 y/o male with symptoms of exertional dyspnea and chest pressure.  Cath shows an anomalous RCA from the Left coronary sinus of Valsalva. The left main, LAD and Cx are normal in origination and morphology; The RCA itself appears without stenosis although a CT Angio described an acute angulation of its orifice and a "possible" slit-like orifice.  The  RCA on CTA courses between the AO and the PA. The patient did walk for 11 minutes on the treadmill, but was SOB and had mild chest pressure at the end of the test. No EKG changes were noted; Echo is normal; no other anomalies.  Bypass? Reimplant?  Any thoughts appreciated.