case_images: PMC11724727_01
case_images: Continuous wave Doppler tracing across aortic valve demonstrating severe aortic stenosis.
case_images: CRIC2025-1450803.001.jpg
case_images: PMC11724727_01_CRIC2025-1450803.001.jpg
case_images: fig1
case_images: A transthoracic echocardiogram demonstrated that his aortic stenosis had progressed from moderate to severe (AVA 0.8 cm2, DVI 0.22, peak velocity 4.2 m/s, mean gradient 45.7 mmHg) (Figure 1).
case_images: (a) Left anterior oblique coronary angiogram of the right coronary artery demonstrating the high anterior origin of the coronary. (b) Right anterior oblique coronary angiogram of the right coronary artery demonstrating the high anterior origin of the coronary.
case_images: CRIC2025-1450803.002.jpg
case_images: PMC11724727_01_CRIC2025-1450803.002.jpg
case_images: fig2
case_images: The RCA was eventually engaged with an Amplatz Right 2 (AR2) catheter and was noted to have a high and anterior origin (Figures 2(a) and 2(b)) For the planning of his aortic valve replacement, he underwent a CT transcatheter aortic valve replacement (TAVR) protocol which revealed an anomalous origin of the RCA off of the left coronary cusp (Figure 3).
case_images: CT angiogram reveals the anomalous origin of the right coronary artery of the left coronary cusp with a slit-like opening and an interarterial course.
case_images: CRIC2025-1450803.003.jpg
case_images: PMC11724727_01_CRIC2025-1450803.003.jpg
case_images: fig3
case_images: The RCA was eventually engaged with an Amplatz Right 2 (AR2) catheter and was noted to have a high and anterior origin (Figures 2(a) and 2(b)) For the planning of his aortic valve replacement, he underwent a CT transcatheter aortic valve replacement (TAVR) protocol which revealed an anomalous origin of the RCA off of the left coronary cusp (Figure 3).
case_images: Balloon expansion of the 29-mm Sapien 3 valve.
case_images: CRIC2025-1450803.004.jpg
case_images: PMC11724727_01_CRIC2025-1450803.004.jpg
case_images: fig4
case_images: The patient underwent a successful TAVR (Figure 4) and reports feeling a significant improvement in symptoms following valve intervention.