Introduction
Coronary artery anomalies are a diverse group of rare congenital
disorders with wide range of clinical presentations (1). Most of these
anomalies are detected incidentally during diagnostic coronary
angiography or at autopsy studies, however they got significant clinical
importance since they are considered as the second most common cause for
sudden death after exertion in young athletes next to hypertrophic
obstructive cardiomyopathy (1).
In this case we present a very rare coronary artery anomaly in an
elderly patient who presented with acute coronary syndrome and found to
have anomalous left main arising from the opposite sinus associated with
severe atherosclerotic disease involving both the normal and anomalous
coronary arteries and who was managed by coronary artery bypass
grafting.