[Anomalous origin of coronary arteries in adults]

[Ectopic connection of the left coronary artery with the contralateral sinus with or without intramural pathway: how and why differentiating them?]

Among the wide spectrum of congenital abnormalities of coronary arteries, a left coronary artery connected with the contralateral sinus is considered as an anatomical high-risk while associated with a proximal preaortic course. The ectopic connection may be associated with or without intramural pathway regarding the aortic wall. An intramural pathway is a characteristic to be considered because it is able to be involved in myocardial ischemia-related adverse events of which the sudden death. Therefore, making an identification of an intramural pathway is essential for the ectopic connections of the left coronary artery associated with a preaortic course.

[Single coronary ostium: single coronary artery and ectopic coronary artery connected with the contralateral artery. How and why differentiating them?]

Among the wide spectrum of congenital abnormalities of coronary arteries, a single coronary artery is often confused with an ectopic coronary artery connected with the contralateral coronary artery. Both abnormalities are characterized by a single coronary ostium, but they differ by the lack or not of an initial ectopic course. The prognosis of anomalous connections of coronary arteries depends mainly on the type of the initial course in relation to other cardiac structures. Therefore, the distinction between a single coronary artery and an ectopic coronary artery connected with the contralateral artery is of importance.

Anomalous origin of the left main coronary artery. Surgical management

A 53-year-old man, with no medical history, presented with acute coronary syndrome. Coronary angiography revealed a common right ostium giving rise to both the right coronary artery and the left main coronary artery. The left interior mammary artery was used as a single bypass graft to the left anterior descending coronary artery. The patient was asymptomatic on follow-up.