single coronary artery with anomalous origin of the right coronary artery from the distal portion of left circumflex artery: a very rare case

congenital anomalies of coronary arteries, albeit rare, may be significant contributors to angina pectoris, hemodynamic abnormalities, and sudden cardiac death. a 47-year-old man referred to us with atypical chest pain. electrocardiography demonstrated no significant ischemic changes, but cardiac troponin i test was positive. the patient underwent coronary angiography, which revealed a single coronary artery from the left valsalva sinus. in addition, the left anterior descending (lad) and the left circumflex (lcx) arteries were in normal position with significant stenosis in the mid-portion of the lad and the distal portion of the lcx. a large branch originated from the distal portion of the lcx and tapered toward the proximal portion as the right coronary artery (rca). this is a rare coronary anomaly that has no ischemic result. coronary lesions were the cause of the patient’s angina pectoris. angioplasty and stenting of the lad and lcx was done, and medical therapy (clopidogrel, aspirin, atorvastatin, and metoprolol) was continued. the patient was asymptomatic at 8 months’ follow-up.