Origin of all three coronaries separately from right sinus of valsalva - A rare anomaly

Anomalous coronary artery origin from opposite sinus is uncommon and separate origin of all three coronary arteries from right sinus of valsalva is exceptionally rare. The anomaly may cause ischemia due to atherosclerosis or due to altered ostial configuration, its exit angulations from the aorta, route of the artery, and intussuception. Various imaging modalities such as echocardiography, coronary angiography, computed tomography, and magnetic resonance imaging have been used to diagnose origin and course of anomalous coronary arteries. Management includes medical treatment and percutaneous or surgical revascularization. Percutaneous coronary intervention is technically challenging and needs judicious selection of guide catheters. We report a patient who presented with inferior wall myocardial infarction and separate origin of all three coronaries from right sinus of valsalva with successful percutaneous revascularization.