Right coronary artery arising from the left main stem with dynamic compression by great vessels

Anomalous origin of the right coronary artery from the left main stem is a very rare congenital anomaly. The entrapment of its course between the aorta and pulmonary artery can cause dynamic blood flow limitation. We report a 68-year-old female presenting with recurrent chest pain and a positive treadmill exercise test. The coronary angiography disclosed anomalous origin of the right coronary artery from the left main stem with dynamic compression between aortic root and pulmonary trunk during the systolic phase. With hesitation about surgical revascularization, the patient was maintained on oral medication uneventfully.