We describe an extremely rare case of a 37-year-old female patient who presented with exertional angina and was diagnosed with a unique coronary anomaly with an anomalous right coronary artery with origin in the left anterior descending artery and a fistula between this anomalous coronary artery and the pulmonary artery.
Most patients with coronary anomalies are asymptomatic but some may have angina caused by a coronary steal phenomenon, myocardial infarction, or even sudden death depending on the circuit and characteristics of the anomaly.
The combination of multiple coronary anomalies is extremely rare.
Despite being a rare diagnosis, coronary anomalies should always be considered as a cause of myocardial ischemia, especially in young patients with low probability for coronary obstructive disease.
Abbreviations:ARCA (anomalous origin of the right coronary artery), CTA (computed tomography angiography), Cx (circumflex artery), ECG (electrocardiogram), ICA (invasive coronary angiography), LAD (left anterior descending coronary artery), LM (left main coronary artery), PA (pulmonary artery), PDA (posterior descending artery), RCA (right coronary artery), RI (ramus intermedius)
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Published online: May 19, 2022
Accepted: April 18, 2022
Received in revised form: April 10, 2022
Received: February 4, 2022
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.