An Unusual Pattern of All Three Coronary Arteries Originating from a Single Coronary Artery Arising from the Right Sinus of Valsalva
A 48-year-old woman presented with exertional angina and palpitations for a long time. She a had medical history of hypertension and dyslipidemia, and a family history of coronary artery disease. Her father had a heart attack at an early age. The electrocardiogram showed normal sinus rhythm and nonspecific ST-T wave changes. Labaratory examinations were unremarkable. The exercise electrocardiogram showed dynamic changes with ST-segment depression in the V 1-4 leads. Echocardiography revealed preserved left ventricle systolic function and concentric left ventricle hypertrophy. The coronary angiography procedure was started with a LCA cannulation attempt, but left anterior descending coronary artery and Cx imaging was unsuccessful even though contrast was injected into the left coronary sinus. The right coronary artery was cannulated and visualized with a right Judkins catheter. At this time, we noticed the left coronary arteries arising from the right sinus of Valsalva. The right Judkins catheter was gently pull back and the left coronary arteries were clearly visualized ( and ). There was no significant stenosis of any of the three coronary trees. Coronary CT angiography confirmed that the left coronary arteries arose from the right sinus of Valsalva and that all three coronary arteries originated from the single sinus (). The patient was managed with conservative treatment and has had no symptoms on clinical follow-up.