Brief Answer:
I would recommend as follows:

Detailed Answer:

Hello!

Thank you for asking on HCM!

I understand your concern, and would like to explain that the anomalous origin of the right coronary artery from the opposite sinus of Valvalva, is one of the main congenital anomalies of coronary arteries.

As this is a serious situation, confirmed as one of the underlying causes of syncope and sudden death in young adults (mainly in athletes), especially if RCA is compressed between Aorta and pulmonary artery, there is a mandatory need for a serious evaluation and vigorous treatment.

I would suggest as follows:

(1) It is very important to identify the exact anatomy of the anomalous coronary artery. Angio CT and more precisely coronary angiography are mandatory to clarify this issue.

Based on these findings and the available medical expertise on the attending medical center, would also depend the most appropriate management strategy.

(2) Corrective surgical re-implantation of the anomalous-originated coronary artery is a preferred procedure, especially in young adults, as it offers a more stable long term outcome, compared with traditional bypass surgery and graft implantation.

Different techniques, like unroofing the intramural segment of the vessel within the aortic wall, and/or osteoplasty are possible, depending on the level of surgical team expertise.

Stenting the stenotic coronary segment is also an option, but remains challenging because of technical difficulties, uncertainties regarding long term outcome. It is highly dependent on medical expertise.

(3) I could not see your Stress Thalium scan report (please could you try to upload it again!). Nevertheless, as cardiac stress tests (traditional one, or even other perfusional imagine techniques, like Thallium scan, or even cardiac MRI techniques, etc) are very important to make evidence of any ischemic myocardial implications by the underlying anomaly, I would highly recommend to proceed with coronary angiography, and if stenosis confirmed with the available corrective therapy.

Sometimes, a life-threatening complication, like syncope, or sudden death, may be the first presentation of the disorder. So nothing to be neglected.

Hope to have been helpful!

Feel free to ask me whenever you need. Greetings! Dr. Iliri

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Brief Answer:
Coronary angiography will clarify anatomical issues.

Detailed Answer:

Hello again!

Your Stress Thallium scan results seem encouraging. Nevertheless, it is highly recommended to clarify the anatomical issues of the underlying anomaly (by coronary angiography).

If this abnormally originated RCA stenosis and topography are confirmed by coronary angiography, there is no doubt for a prompt intervention necessity, as this is a very dangerous situation (facing your recurrent typical chest pain).

Regarding your cough feeling and green colored phlegm, it is compatible with a respiratory way infection, and should be properly treated (a prolonged and combined antibiotics regimen may be necessary).

Your have to follow a daily treatment regimen with a PPI (pantoprazole, omeprazole, etc) for your acid reflux.

After performing the anatomical coronary study, and treating your associated health conditions, everything will be clear, and the right decision will be taken.

Best regards! Dr. Iliri

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