Rationale: High take-off of the coronary arteries is a rare cardiac anatomic anomaly, which may occur independently or with other congenital heart defects. In the clinical setting, it is noteworthy as a cause of sudden cardiac death. Further, it is vital to identify such anomalies to avoid intraoperative catastrophes in surgeries for congenital heart defects.
Patient concerns: A II/6 systolic heart murmur on physical examination was incidentally found in a 9-year-old boy; he was confirmed to have a secundum-type atrial septal defect on echocardiography. He was referred to our institution for elective surgery.
Diagnoses: The preoperative echocardiogram confirmed the presence of an atrial septal defect, and during the surgical procedure, a high take-off right coronary artery was found.
Interventions: The atrial septal defect was closed surgically, and care was taken to avoid clamping the anomalous right coronary artery when placing the aortic cross-clamp.
Outcomes: Postoperative echocardiogram verified the presence of the high take-off right coronary artery and a satisfactory repair of the atrial septal defect. The postoperative course was uneventful, and the patient was discharged on postoperative day 5.
Lessons: This case suggests that it is critical to perform echocardiography to assess the anatomy of the coronary arteries, especially in pediatric cardiac patients. In addition, multi-detector computed tomography may be considered if appropriate. Care should be taken to assess the coronary anatomy for anomalies during interventional therapy or surgery, especially in congenital cases.