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.