Anomalous left coronary artery: prepulmonic course

Case contributed by Dr Yune Kwong


Abnormal coronary angiography - for characterization.

Patient Data

Age: 65 years
Gender: Male

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).

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Case Discussion

An anomalous coronary artery arising from the opposite sinus usually takes four common courses:

  1. 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)
  2. retroaortic
  3. prepulmonic
  4. transseptal (subpulmonic)

In the case above, the course of the LAD is prepulmonic, and this is not a malignant course.

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