Chest Pain in a Patient With an Anomalous Coronary Artery and Multiple Valvular Diseases: What is the Culprit?

Rare congenital abnormalities known as “coronary artery abnormalities (CAAs)” have various pathophysiological causes and clinical manifestations. We describe a 50-year-old man who complained of recurrent shortness of breath. The patient had a 3-day history of the condition, which worsened with exertion. A coronary angiography, followed by a coronary computed tomography angiography, showed that the ostium of the left main coronary artery (LMCA) originated from the proximal right coronary artery. Our elderly patient with an uncommon CAA also had significant aortic stenosis. Coronary angiography and coronary computed tomography angiography are crucial procedures in these patients to confirm the diagnosis and choose the appropriate course of action. Despite its debatable effectiveness, coronary artery bypass grafting may be an option for young patients suffering from CAAs with interarterial courses, such as the left major coronary artery originating from the right coronary artery. (Iranian Heart Journal 2024; 25(1): 93-97)