# Anomalous Right Coronary Artery in the Setting of Active Tuberculosis: A Multidisciplinary Management Challenge

## TL;DR

A 62-year-old man with a rare heart condition and active tuberculosis was managed without surgery, showing the need for personalized care in complex cases.

## Contribution

This case report highlights the challenges and non-operative management of ARCAPA in a patient with active tuberculosis and multiple comorbidities.

## Key findings

- ARCAPA was diagnosed using coronary angiography and CT imaging in a patient with chest pain and atrial fibrillation.
- Non-operative management was chosen due to the patient's comorbidities and preserved heart function.
- Advanced imaging confirmed collateral circulation and perfusion deficits, guiding a conservative treatment approach.

## Abstract

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.