MediAI

  Introduction Coronary artery anomalies (CAAs) are relatively rare congenital abnormalities, yet they are clinically significant due to their potential association with myocardial ischemia, arrhythmias, and sudden cardiac death (SCD). Among the various types of CAAs, the so-called “malignant” interarterial course —in which a coronary artery passes between the aorta and the pulmonary artery—is particularly dangerous. This variant is most frequently identified in the right coronary artery (RCA) or the left coronary artery (LCA) arising from the opposite sinus of Valsalva. Although the overall prevalence of CAAs is less than 1% in the general population, this anomaly is disproportionately represented among cases of sudden death in young athletes and military recruits. Consequently, early recognition and appropriate management are paramount. In this article, we provide a comprehensive, expert-level review of the malignant interarterial course of coronary arteries, focusing on t...