Coronary artery congenital anomalies occur in 0.3–1.3% of the general population among whom most of the cases never represent cardiac symptoms such as arrhythmia or dysfunction [1]. Accordingly, the detection of these anomalies is limited to incidental findings during coronary artery angiography or computed tomography angiography (CTA) performed for other cardiac pathologies [2]. Nevertheless, some of these anomalies might lead to impaired myocardial perfusion or cause fatal complications [3].

Coronary computed tomography angiography (CTA) is currently the best modality to diagnose R-ACAOS and its course [4]. According to the guidelines, R-ACAOS is divided into five categories including interarterial, subpulmonic, pre-pulmonic, retroaortic, and retrocardiac considering the course that the coronary artery takes to reach its dependent myocardial territory. R-ACAOS with an interarterial course is known as the malignant coronary anomaly [2]. R-ACAOS is widely associated with increased risk of syncope, arrhythmia, myocardial infarction, and SCD. Accordingly, the surgical correction of R-ACAOS is controversial and requires precise assessment of the potential for SCD incidence [5].

Given that, the current study aims to investigate the cardiac-related disorders among the patients with incidental R-ACAOS diagnosis.