Congenital Coronary AnomaliesInterarterial course of anomalous right coronary artery: role of symptoms and surgical outcomesSaleem, Sameera; Syed, Mubbasherb; Elzanaty, Ahmed Mc; Nazir, Salikb; Changal, Khalidb; Gul, Sajjadd; Sheikh, MujeebbAuthor Information aDepartement of cardiovascular medicine, University of Kentucky, Bowling Green, Kentucky bDepartement of cardiovascular medicine, University of Toledo Medical Center, Toledo, Ohio cDepartement of Hospital medicine, University of Illinois, College of Medicine at Peoria, Illinois dDepartement of Internal medicine, University of Toledo Medical Center, Toledo, Ohio, USA Received 1 November 2019 Accepted 13 March 2020 Correspondence to Ahmed M. Elzanaty, MD, Departement of Internal Medicine, University of Toledo, 3000 Arlington Ave, Toledo, OH 43614, USA, Tel: +419 383 4000; fax: +419 383 6180; e-mail: Ahmed.firstname.lastname@example.org Coronary Artery Disease: September 2020 - Volume 31 - Issue 6 - p 538-544 doi: 10.1097/MCA.0000000000000893 Buy Metrics Abstract Anomalous origin of right coronary artery with interarterial course (ARCA-IA) is a risk factor for sudden death and other cardiac complications. Surgical correction remains its gold standard treatment. We describe clinical characteristics, workup, surgical techniques and outcomes of ARCA-IA at our center. A retrospective analysis of cardiovascular database was performed. From March 2005 through January 2011, 11 patients with mean age of 53 ± 18 years were diagnosed with ARCA-IA. Reported symptoms included chest pain (64%), arrhythmia [27%; i.e. atrial flutter (9%), recurrent supraventricular tachycardia (9%), ventricular tachycardia (9%)], syncope (18%), dyspnea (9%) and aborted sudden cardiac death (9%). Chest pain (n = 7) was episodic and lasted longer than 6 months before diagnosis. Initial diagnosis was made at coronary computed tomography in two patients and at cardiac catheterization in nine patients. Four patients had positive stress test and were subsequently found to have ARCA-IA at cardiac catheterization. There was no operative mortality. Surgery (bypass with ligation of native vessel or translocation and reimplantation) was performed in seven patients. Three patients refused surgery, and in one patient, surgery was not considered due to comorbidities. Symptom relief was noted in all surgical patients. At mean follow-up of 36 months, two patients had noncardiac-related deaths whereas nine were asymptomatic. There were no deaths reported in patients treated surgically. Definitive surgery is indicated in symptomatic ARCA-IA and is associated with excellent long-term outcome. RCA dominance in ARCA-IA is an adverse marker with increased symptoms; this hypothesis should be tested in larger studies. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.