Anomalous origin of the right coronary artery from the left coronary sinus with medusa head left coronaries: Plethora of left coronary circulation with paucity of right one

We report a rare case of anomalous origin of right coronary artery (RCA) from the left coronary sinus with a peculiar medusa head pattern of left coronary system in an octogenarian presenting with inferior wall myocardial infarction. Although anomalous origin of RCA from the left coronary sinus is the most common anomaly to be reported, this rare association of extensive arborization of left coronary system appearing like a medusa head is not reported in literature so far. The anomalous RCA harbored critical mid-RCA lesion, but the crux of coronary intervention was that we engaged the anomalous RCA with extra back up guide catheter in place of conventionally used Judkins right guide catheter to engage the anomalous origin and accomplished the coronary intervention with buddy wire technique. Our case is unique and the first to describe the association of medusa head appearance of left coronary circulation in a case of anomalous origin of RCA from the left coronary sinus.