Rare coronary anomaly: Common origin of major coronary arteries from the right sinus of Valsalva and a small ramus branch originating from the left sinus of Valsalva

Abstract

We present a clinical case where coronary computed-tomography angiogram (CTA) findings on admission had crucial role for clinical diagnosis and management of the patient. A 67-year-old woman with no prior history of coronary artery disease (CAD) was admitted with chest pain and dyspnea for past several weeks. Her initial electrocardiogram and cardiac biomarkers were unremarkable. She was referred for a coronary CTA to rule obstructive CAD as a reason for her symptoms. The coronary CTA showed a common origin of all three major epicardial arteries from right sinus of Valsalva forming a trifurcation, and a small ramus intermedius branch originating from left sinus of Valsalva. The right coronary artery gave rise to the left circumflex artery which had a retroaortic course, and the left anterior descending artery demonstrated an interarterial course (highrisk variant). There was an occlusion of the mid right coronary artery, with associated inferior wall motion abnormality and borderline reduced left ventricular systolic function (Fig. 1). These findings were confirmed on invasive coronary arteriography (Fig. 2, Video 1–4). The patient subsequently underwent coronary artery bypass surgery with a saphenous venous graft to posterior descending artery, and a left internal mammary arterial graft to left anterior descending artery. At 9-month follow-up, the patient denied angina or dyspnea and was doing well.