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A 62-year-old gentleman was referred for coronary surgical revascularisation due to increasing symptoms of angina pectoris. Preoperative coronary angiography showed the left main coronary artery (LMCA) arising adjacent to the right coronary from the right coronary sinus (figure 1). The left anterior descending artery coursed at 90°s to the LMCA with the circumflex artery a continuation of the LMCA. Obtuse marginal branches of the circumflex are also visible. There was surgically graftable three vessel disease with preserved left ventricular function. The patient had coronary artery bypass grafting performed.
Intraoperatively, the LMCA was noted traversing the anterior aspect of the right ventricular outflow tract giving rise to the left anterior descending and circumflex arteries as suggested on the angiogram (figure 2). Postoperative course was uneventful with discharge home on the sixth postoperative day.
This is a described coronary anomaly but is exceedingly rare. A series of 126 595 patients having coronary angiography noted origin of LMCA from the right coronary sinus in a total of only 22 (0.017%) with this ‘anterior’ course the least common of five subtypes.1
Contributors: Both listed authors have been involved in the conception, drafting and final approval of the manuscript.
Competing interests: None.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; internally peer reviewed.