Rare malignant anomalous right coronary artery incidentally detected by dual source computed tomography angiography in an adult referred for transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is a safe treatment option for elderly patients with aortic stenosis (AS) with high or intermediate surgical risk. The anomalous origin of coronaries from a single Valsalva sinus has a higher risk of coronary obstruction during the TAVI procedure, so prior knowledge of these anatomical variants is of paramount importance as it can change the surgical strategy. In this report, we present the case of an adult patient suffering from severe aortic stenosis and incidentally diagnosed with an anomalous malignant variant of right coronary artery (RCA) by pre-procedural Computed Tomography (CT) Angiography. In TAVI planning, the use of electrocardiography (ECG) gated Dual Source CT (DSCT) enables accurate coronary and aorto-iliac vascular study, useful for detecting congenital coronary anomalies.