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An 88 year old woman with systemic hypertension presented with progressive hoarseness due to the presence of a thoracic aortic aneurysm (TAA). She had not experienced any chest pain. As part of her preoperative evaluation, coronary angiography was performed. During coronary angiography, the catheter for the right coronary artery (RCA; 4 French, Judkins RCA 4.0) could not engaged the ostium of the RCA and the injection of contrast medium in the right sinus of Valsalva showed that the RCA did not originate from the right sinus of the Valsalva. Angiography of the left coronary artery revealed that the RCA originated from the proximal left anterior descending coronary artery (LAD) between the septal branch and first diagonal branch (left panel). There was no significant stenosis in any of the coronary arteries. To exclude the presence of an origin of a supplementary RCA from another site, such as the pulmonary artery, 16 row multidetector computed tomography (MDCT) was performed. The MDCT (panels A and B) revealed that the RCA originated from the proximal LAD, traversed in front of the pulmonary artery, and ran down along the atrioventricular groove between the right atrium and right ventricle. The patient underwent insertion of an endovascular stent graft to treat the TAA and the postoperative course was uneventful. Anomalous origin of the RCA from the LAD is quite rare but this type of anomalous coronary anatomy may not influence the coronary blood flow to the RCA and is associated with good prognosis.
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