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Background: Anomalous origin of coronary arteries is a relatively rare entity, which may show different clinical forms and develop an adverse outcome. Multislice coronary angiotomography has gained importance in daily clinical practice, representing an important patient assessment method with great potential in the anatomical evaluation of these arteries., Objective: This study aimed to describe angiotomographic findings and evolution of patients with anomalous origin of coronary arteries., Methods: From January 2008 to March 2011 404 patients were evaluated consecutively, who had been referred for coronary angiotomography for several reasons, with a mean follow-up of 21 months., Results: Nine patients (2.2%) had anomalous origin of coronary arteries, of which four had an anomalous origin of the Circumflex (Cx) artery in the Right Coronary Artery (RCA), two had anomalous origin of the RCA (one originating from the Cx and one in the left coronary sinus), a patient with single coronary trunk (anterior descending and Cx out of the left coronary sinus), one had anomalous left main coronary artery trajectory between the aorta and pulmonary artery and one patient with left coronary trunk originating from the right coronary sinus. Of the evaluated patients, one received an implantable cardiodefibrillator; one died due to sudden death during hospitalization; and the others showed no complications., Conclusion: The multislice coronary angiotomography represents minimally invasive assessment method that allows detecting the origin, course and termination of anomalous coronary arteries with excellent accuracy, allowing the correct diagnosis and aiding therapeutic planning.

We report the case of a rare anomaly of the right coronary artery (RCA) arising from the left aortic sinus, having a single ostium with the left coronary artery, associated with documented episodes of inferior ischemia, in which surgical treatment with a right internal thoracic artery to RCA bypass graft and the corresponding ligation provided greater stability to the coronary blood flow and good clinical progress.

We present a case of a patient who underwent coronary angiography in a setting of acute myocardial infarction, which showed an independent origin of all three coronary arteries from the right coronary sinus. This has rarely been described in the medical literature.

We report the case of a patient with complete heart block caused by extension of a congenital aneurysm of the sinus of Valsalva into the upper interventricular septum, which was diagnosed by transthoracic and transesophageal echocardiography. We emphasize the rarity of this pathology and the value of transesophageal echocardiography in its assessment, providing a complete anatomicofunctional characterization and allowing surgical repair without previous cardiac catheterization.

A 30 years old, male, patient with rare multiple aneurysms of sinus of Valsalva associated to mitral and aortic regurgitation and total occlusion of circumflex artery had the clinical diagnosis made accidentally. The multiple aneurysms were detected by transesophageal echodopplercardiography and hemodynamic study. The diagnosis were confirmed at surgery and the patient underwent correction of the aneurysms through the use of pericardial patches and mitral and aortic valve replacement.

A 35 year-old man with aneurysm of the noncoronary sinus of Valsalva ruptured into the right atrium, detected by echodopplercardiogram and submitted to surgical correction is reported. The authors discuss peculiar aspects of this disease, with emphasis to the echodopplercardiographic diagnosis.