FFRCT for Physiologic Assessment of Anomalous Right Coronary Artery Before and After Surgical Repair

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Anomalous aortic origin of the right coronary artery (AAORCA) with an intramural course is rare and may be associated with ischemia and sudden death. Surgical unroofing is standard for symptomatic patients. Coronary CTA defines anatomy but not physiology; and stress testing is often inconclusive. CT-derived FFR (FFRCT) offers noninvasive physiologic assessment. CASE A 44-year-old woman developed exertional chest pain, dyspnea, and presyncope. Holter monitor showed nonsustained VT. Stress echocardiogram was normal. CTA demonstrated anomalous RCA with interarterial/intramural course and slit-like ostium. FFRCT distal to the intramural segment was 0.74 suggestive of lesion specific ischemia. The patient underwent successful surgical unroofing (marsupialization) with resolution of symptoms. She presented five years later with chest pain and underwent repeat imaging. CTA/ FFRCT displayed shift of the ostium due to surgical unroofing and normalization of FFRCT values. DECISION-MAKING FFRCT identified ischemia despite a normal stress test, supporting the decision for surgical unroofing. Postoperative CTA/FFRCT confirmed successful anatomic correction and resolution of ischemia related to the coronary anomaly. CONCLUSION FFRCT identified ischemia in AAORCA with an intramural course and showed durable resolution post-repair, supporting its role in guiding and validating treatment.

Volume

87

Issue

13 Suppl

First Page

A1821

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1822

DOI

10.1016/j.jacc.2026.02.4543

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