Presentation
Abnormal coronary angiography - for characterization.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
Both the right coronary artery (black arrow) and left main stem (white arrow) arise from the right coronary sinus (from separate ostia). The left main stem has a pre-pulmonic course, passing anterior to the right ventricular outflow tract.
The left main stem bifurcates into the left anterior descending artery (blue arrow) and circumflex artery (green arrow).
Case Discussion
An anomalous coronary artery arising from the opposite sinus usually takes four common courses:
- interarterial (i.e. between the aorta and the pulmonary artery) - this is the most dangerous as it carries a high risk of sudden cardiac death (malignant course)
- retroaortic
- prepulmonic
- transseptal (subpulmonic)
In the case above, the course of the LAD is prepulmonic, and this is not a malignant course.
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