A Case of Bypass Grafting for Angina Pectoris with Anomalous Origin of the Left Anterior Descending Artery from the Right Coronary Artery

A 55-year-old man was admitted to our hospital with angina pectoris. Coronary angiography revealed that the left anterior descending artery (LAD) originated from the proximal right coronary artery (RCA) which arose from the right coronary sinus of Valsalva, while the circumflex artery (CX) arose from the left coronary sinus of Valsalva. Multiple coronary lesions included total obstruction at the proximal RCA after branching the LAD, 75% stenosis at the origin of the LAD, and 90% stenosis at the proximal CX. These lesions were revascularized with the left interthoracic artery to the LAD, the radial artery to the RCA, and a couple of saphenous vein grafts to the CX. Postoperative angiography confirmed patency of all grafts. Anomalous coronary artery is found to be 0.62-0.83% by angiography. A rare anomalous coronary artery is documented in this article, which has been reported to be 4.4% of all anomalous coronary arteries.