Anomalous Origin of all Coronary Arteries from Right Sinus of Valsalva (RSOV)

Case A 70-year-old man admitted for chest tightness on exertion for approximately 5 days. The patient had a history of systemic hypertension as risk factor for coronary artery disease. He had no history of tobacco or alcohol use. Physical examination was normal. His resting electrocardiogram was normal. Electrocardiography revealed normal sinus rhythm with no ST segment changes. Echocardiography revealed normal left ventricular function. The patient referred for catheterization due to suspected coronary artery disease with angina. Angiography through the right radial artery and use of a 6F left Judkins catheter was unable to cannulate the ostium of main stem. With the use of the same catheter selective injection of the right coronary artery revealed a single coronary artery (right coronary artery) and left main (LM) arising from the same right coronary ostium. Following the course of the coronary vessel LM was divided to left anterior descending artery (LAD) and left circumflex artery (LCX). The coronary artery was free of atherosclerotic changes and no intervention was planned. Figure 1: Anomalous origin of the LM from the RSOV.