ABSTRACT
The finding of a left main coronary artery arising from the right sinus of Valsalva is a rare congenital anomaly. The clinical course of patients with a congenital anomaly of the coronary artery may be compromised depending on its anatomic relationship with adjunctive structures. Some anomalous origins of the left main coronary arteries arising from right aortic sinus of Valsalva have been associated with angina pectoris and sudden death, especially if their pathways are between the pulmonary artery and the aorta. We report a rare case with a combined congenital anomalous origin of the left main coronary artery arising with the right coronary artery simultaneously from the right aortic sinus of Valsalva in a patient with a patent ductus arteriosus. The left main coronary artery was extremely long because its pathway went in front of the pulmonary artery. There was no evidence of artherosclerosis or dynamic stenosis on the angiogram.