Anomalous Right Coronary Artery Originating From the Left Anterior Descending Artery

A69-year-old man with diabetes mellitus presented at our hospital with exertional chest pain. An exercise test showed a horizontal ST depression in the lateral leads. Multidetector computed tomography revealed a single coronary artery arising from the left sinus of Valsalva and an anomalous branch originating from the midportion of the left anterior descending (LAD) artery that traversed to the right side of the heart along the course of the right coronary artery (RCA). Diffuse calcification in the midportion of the LAD artery indicated stenosis in this section (Fig 1). Coronary angiography revealed severe stenosis in the ostium of the anomalous RCA and around the bifurcation of the LAD artery (Fig 2). He underwent off-pump coronary artery bypass grafting for the LAD artery and anomalous RCA. The left internal thoracic artery (LITA) was anastomosed to the LAD artery, and a saphenous vein graft (SVG) was anastomosed to the proximal portion of the anomalous RCA. The postoperative course was uneventful, and all grafts were patent (Fig 3). An anomalous RCA arising from the LAD artery is extremely rare, and few surgical interventions have been reported. Multidetector computed tomography can provide an accurate diagnosis and valuable information for preoperative planning.