Congenital absence of the right coronary artery with chronic total occlusion of the left coronary artery: a rare clinical situation

Abstract: In the literature, few cases of absence of the coronary artery have been reported. In addition, the absence of the right coronary artery (RCA) with chronic total occlusion (CTO) of the left coronary artery is uncommon. We present the case of a Mexican patient with a history of exercise-induced chest pain in which a congenital absence of RCA with CTO was confirmed by coronary angiography. The patient was discharged symptom-free and remained so after conservative treatment. The absence of coronary arteries results from abnormal embryonic development, with various clinical manifestations; most patients show symptoms of myocardial ischemia. This case illustrates the importance of coronary angiography for diagnosis, which is considered the gold standard. However, there are no standardized treatment guidelines; conservative or revascularization therapy may be used to treat the condition. Due to its extremely low incidence, it is challenging to determine the prognosis of this coronary anomaly.