Rare Variant of Left Circumflex Coronary Artery Originating From the Right Coronary Artery

Coronary artery anomalies are rare in the general population. Many individuals with coronary artery anomalies are asymptomatic. Some individuals with these anomalies have an increased risk of sudden cardiac death (SCD), especially young athletes, and an elevated risk of myocardial ischemia with anginal symptoms, seen in older age groups. We report a 43-year-old male who received coronary artery bypass graft (CABG) surgery for the four-vessel disease after suffering from an anteroseptal myocardial infarction (MI). The patient presented to the hospital emergency department with episodes of chest pain for three days. On coronary angiography, an anomalous origin of the left circumflex coronary artery (ALCx) was visualized. This ALCx was a type I variant originating from a separate ostium from the right coronary artery (RCA) at the right coronary cusp.  It is important to document and describe the different variants of coronary anomalies to provide proper patient management. The anomalous origin of the left circumflex coronary artery from the right coronary cusp of the RCA is considered a benign variant. It may, however, have been instrumental in supplying blood to the left heart in the setting of complete left coronary artery (LCA) occlusion.