Dual Origin of the Left Coronary Artery with Vestigial Branch Arising from the Aorta and Main Trunk Arising from the Pulmonary Artery

A 3-month-old infant presented with cardiomegaly, mitral insufficiency, myocardial ischemia, and congestive heart failure suggestive of anomalous left coronary artery. A vestigial left coronary artery was demonstrated on angiography and was thought to represent the only abnormality. At autopsy, the infant had a vestigial left coronary artery arising from the aorta but in addition had a normal caliber anomalous left coronary artery arising from the pulmonary artery.