Interesting case of anomalous origin of right coronary artery from left sinus.

Anomalous coronary arteries (acas) are rare but potentially life-threatening abnormalities of coronary circulation. Most variations are benign; however, some may lead to myocardial ischemia and/or sudden cardiac arrest.1 We present a case of 55-year-old male with a significant medical history of hypertension, hyperlipidemia, type 2 diabetes and gastroesophageal reflux disease who presented to the emergency department with atypical chest pain. He underwent a cardiac catheterization that showed coronary artery disease with tight lesions in both Left anterior descending and Left circumflex along with anomalous right coronary artery originating near the anterior left coronary artery sinus and coursing between the pulmonary artery and aorta. The patient was taken up for coronary artery bypass grafting of LAD and LCX only, leaving behind RCA and was discharged home after full recovery.Treatment of significant anomalies should be guided by the nature of the anomalous vessel. Symptomatic patients with acas have 3 treatment options: medical management, coronary angioplasty and stent deployment, or surgical correction. Some clinicians advocate revascularization, but the long-term benefits of revascularization therapies have not yet been demonstrated.