Right anomalous aortic origin of a coronary artery (R-AAOCA) is increasingly diagnosed but remains a rare congenital anomaly with potential ischemic risk.
Invasive fractional flow reserve during dobutamine-atropine challenge (FFR-dobutamine) is the reference standard for assessing hemodynamic relevance, but it is invasive and resource-intensive.
Coronary computed tomography angiography (CCTA) offers high sensitivity and negative predictive value for ruling out hemodynamic compromise in R-AAOCA, potentially reducing unnecessary invasive testing.
Functional nuclear imaging has modest sensitivity but excellent specificity and positive predictive value, making it a useful adjunct to rule in ischemia when indicated.
