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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 2526619310.5144/0256-4947.2014.267asm-3-267ImagesRight coronary artery originated from the left anterior descending artery Kilic Ismail Dogu Alihanoglu Yusuf Yildiz Bekir Serhat Evrengul Harun From the Department of Cardiology, Pamukkale University School of Medicine, Denizli, TurkeyCorrespondence: Yusuf Alihanoglu, Department of Cardiology, Pamukkale University School of Medicine, Denizli 20015, Turkey, F: +90–258–296 23 32, aliizyu@mynet.comMay-Jun 2014 34 3 267 267 Copyright © 2014, Annals of Saudi Medicine2014This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Coronary artery anomalies are congenital abnormalities in the coronary anatomy. The incidence is approximately 1% of the general population. Variations may be in the number, size, and positioning of the ostia or in the course of coronary arteries. A number of anomalous origins for right coronary artery including left anterior sinus, above the sinus level in ascending aorta, descending thoracic aorta, left main coronary artery, circumflex artery, pulmonary arteries, or below the aortic valve have been defined. These images (Figures 1 and 2) show a rare origin site for the right coronary artery from the mid portion of the left anterior descending artery belonging to 2 patients aged 64 and 79 years, respectively. The patients underwent coronary angiography because of the mild ST depressions during exercise testing.

Figure 1 Right coronary artery originating from the midportion of the left anterior descending artery seen in the right anterior oblique cranial (A) and caudal (B) positions. Aortography showing no separate ostium for the right coronary artery (C).

Figure 2 Right coronary artery originating from the midportion of the left anterior descending artery seen in the left anterior oblique cranial (A) and right anterior oblique cranial (B) positions. Aortography showing no separate ostium for the right coronary artery (C).