Primary percutaneous coronary intervention (PCI) of an anomalous right coronary artery (RCA) from ascending aorta in a patient with inferior wall myocardial infarction (IWMI) and cardiogenic shock

Abstract Anomalous origin of the right coronary artery (RCA) from the ascending aorta above the left Sinus of Valsalva is a very rare coronary anomaly which can pose extreme difficulties for the operator, especially in the setting of an acute myocardial infarction. Herein, we describe a patient in whom this very rare anomaly was encountered in a setting of acute inferior wall myocardial infarction complicated by complete heart block and cardiogenic shock. Since we were aware of this anomaly as we had recently encountered and published a case of a similar anomaly in a relatively elective setting, we could successfully manage this case in the acute emergent setting minimising contrast load and avoiding complications.