There are many reports on AAORCA treatments, such as unroofing and coronary artery bypass grafting. However, the number of cases is small, and there are a few reports about long-term outcomes.

In the case of intramural RCA, unroofing may require a procedure to peel off the commissure, which may cause aortic valve regurgitation eventually. It may also be necessary to add pulmonary artery translocation for interarterial RCA [3]. According to the preoperative assessment, we did not select unroofing because RCA might have been an intramural type running behind the commissure.

Coronary artery bypass grafting may require ligation on the proximal portion of RCA due to the risk of flow competition, and graft patency eventually could be an issue in younger cases.

Reimplantation is technically simple, and the lesion is easily approachable, even if a stenotic lesion in RCA occurs in the future. Previous cases also showed that it might enable surgeons to avoid aortotomy [2, 4]. Although, depending on the diameter of the RCA in early childhood, reimplantation could be difficult in principle, it should be considered as an option for adolescent cases with AAORCA. Previous studies that reported on more than 10 cases [1, 2] suggested that anastomosis could be performed if the proximal part of the RCA had a diameter of 3.5 mm because a 3.5 mm puncher was often used to create neo-ostium in the ascending aorta.

The main purpose was to evaluate the distance up to which the proximal part of the RCA could be detached to mobilize it for anastomosis without tension. Detaching the proximal part of the RCA until the first conal branch could be essential [1, 2]. We thought that the assessment of preoperative CT was helpful.

Although there are a few reports on reimplantation, the report by Amadou et al. [2] shows promising results in the mid-term follow-up of 7 years. Thus, it could be an effective method after adolescence.

In this study, there was an aberrant RSCA from the descending aorta. To our knowledge, this is the first surgical report of the AAORCA with aberrant RSCA. If a coronary artery disease might occur in the future period after coronary artery bypass graft with the right internal thoracic artery (ITA) to the RCA, percutaneous coronary intervention could be more difficult through the right ITA. Reimplantation was a good treatment option in this case.