A 70-year-old woman with hypertension presented to our clinic for evaluation of chest pain. A very rare anomaly, in which the right coronary artery originated from the left anterior descending artery, was incidentally found on coronary angiography. The acute angle made by the Anomalous right coronary artery may have reduced the flow velocity and led to signs of myocardial ischemia.

A 50–year–old woman presented to our center with effort angina. Angiography showed normal left main coronary artery, normal left circumflex (LCX) artery and critical discrete lesion (99% stenosis) in mid part of left anterior descending (LAD) artery with good distal flow. However, the right coronary artery (RCA) originated from the left main coronary artery. There was no evidence of external compression of the proximal portion of the RCA during systole or diastole. Consult with cardiac surgeon was done but the patient refused from the operation.

Background: Normal coronary artery anatomy is characterized by two Ostia centrally placed in the right and left sinus of Valsalva. Anomalous origin of the left coronary artery from the Pulmonaryartery (ALCAPA) is a rare congenital anomaly. It is present in one of 300, 000 livebirths. It represents one of the most common causes of myocardial ischemiaand infarction in children with mortality rate of up to 90% within thefirst year of life. Immediate surgical correction is the current standard in patients with ALCAPA.CaseDescription: A 4-months-old infant presented to the hospital with DCMP from 20 days ago, poor feeding, growth failure and sweating occasionally after feeding. In Physical examination there wasn’t cyanosis and was remarkable for dyspnea and wheezing respiration. In ECG abnormal Q wave and ST segment depression remarked, and also an abnormal finding in echoradiography and CXREY was definite. She was admitted with a diagnosis of heart failure. Finally with diagnosis of ALCAPA, Surgical correction was used by anastomosis of LCA to the ascending Aorta via intrapulmonary tunnel. In Postoperative Echocardiography EF were 55-60%, good LCA flow, mild apical dyskinesia and relative good LV function.Conclusion: The surgical results of operations have improved in recent years in this otherwise fatal disease.Because of the importance of immediate surgical correction, appropriate diagnostic Modalities should allow rapid diagnosis of ALCAPA in any patient seen with dilated congestive cardiac failure.

The Anomalous origin of the left anterior descending (LAD) coronary artery from the right coronary artery (RCA) is a rare congenital anomaly. Herein we report an adult male referred to our hospital for an evaluation of his chest pain. Echocardiography revealed hypertrophic cardiomyopathy.coronary angiography revealed an Anomalous origin of the LAD from the RCA. Such an association constitutes an extremely rare congenital condition.

Background and Objective: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare but well-described cardiac anomaly with a frequency of 0. 25-0. 5% among all cardiac anomalies. It is associated with a high mortality rate (90%) in infants (within 1 year of birth) due to inadequate collateral circulation development. However, if good collateral circulation to the left side of the heart is established, the patient may survive into adulthood without complications. Case report: The present report describes an unusual case of a 14-year-old boy who was incidentally diagnosed with ALCAPA and was completely asymptomatic with normal left ventricular ejection fraction. The patient was treated with conservative medical therapy and recommended for regular clinical follow-up. Conclusion: Although our patient’, s parents were not convinced about surgical repair, he could be further treated with conservative medical therapy. However, surgical repair should be performed in all cases of ALCAPA to prevent the progression of ischemia, arrhythmia, congestive heart failure, and even sudden death.

An Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly. It usually presents in infancy with intractable left sided heart failure. Most patients die in infancy, but survival into adulthood is possible. Patients may complain of dyspnea, syncope or effort angina. They may remain asymptomatic; or experience sudden death after exercise. A 56-year-old woman presented with a two month history of exertional chest discomfort. Echocardiography showed a coronary anomaly with preserved systolic function and no resting regional wall motion abnormality. The coronary and CT (computed tomography) angiography studies revealed the Anomalous origin of the left coronary artery. A review of ALCAPA studies is presented along with images from the echocardiogram, coronary angiogram and CT scan performed for this case.

Background and Aim: Anomalous origin of the right coronary artery from the left anterior descending artery is extremely rare. It is usually asymptomatic but can be associated with a risk of myocardial ischemia and sudden death. Case presentation: This paper presents the case of an elderly male with exertional dyspnea. He underwent diagnostic measures including coronary artery angiography which showed severe stenotic three-vessel disease and right coronary artery anomaly. He underwent coronary artery bypass grafting and discharge home in good condition. Conclusion: Although the abnormal origin of the right coronary artery from the left anterior descending artery is a rare anomaly, due to causing chest pain and the possibility of sudden death, it is considered important. For a definite diagnosis of this anomaly coronary angiography is useful.

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which represents one of the most common causes of myocardial ischemia and infarction in children. This anomaly, if left untreated, results in a very high mortality rate within the first year of life. Yet, immediate surgical correction can lead to excellent results.Objectives: The present study aimed to determine the surgical outcome of ALCAPA.Methods: This study was conducted on 53 patients with ALCAPA operated from January 2005 to December 2012. Surgical repair was carried out as soon as the diagnosis was made. Surgery was thus undertaken on an urgent basis (within 48 hours) in the patients with congestive heart failure or critical clinical status and on a semi- elective basis (within a few days) in the remaining children. Operations for all the patients were performed through a median sternotomy using established standard cardiopulmonary bypass technique.Grouped variables were compared using chi-square test with Yates’ correction. Besides, McNemar's test was used to assess the relationship between preoperative ejection fraction and mitral incompetence. All the analyses were performed using the SPSS statistical software, version 11.5 (SPSS Inc., Chicago, IL).Results: The patients' median age at presentation was 4 months. The mean preoperative ejection fraction was 36.5%. The results showed a significant relationship between age at presentation and impairment of ejection fraction (P<0.001). At first, 23% of our patients presented with ejection fraction<35%. However, 6 months after the operation, the ejection fraction improved to a mean of 53.07% (SD=8.5) ranging from 38 - 66%. There were 5 postoperative hospital deaths with an overall mortality rate of 9.6%.Conclusions: Excellent results with desirable long-term outcomes can be achieved in the infants with ALCAPA using coronary artery implantation techniques. The best potential for recovery of the left ventricular function is in younger symptomatic infants despite the worst initial presentation. Normalization of cardiac function is expected within the first year in all operative survivors with a patent dual coronary system.

A double left anterior descending (LAD) coronary artery emerging from the left and right coronary arteries is classified among rare coronary anomalies. We herein report a 73-year-old man presenting with acute coronary syndrome (posterolateral myocardial infarction). He was admitted with typical chest pain, and due to his progressive ischemic changes on electrocardiography (ECG) and elevated cardiac enzyme, he was candidated for cardiac catheterization. The coronary angiography revealed an Anomalous LAD from the right sinus of Valsalva. The unusual coronary anatomy was perfectly matched with the distribution of ischemia and its clinical evidence on echocardiography and ECG. The culprit lesion was stented, and the patient was discharged in good physical condition from the hospital.

A 48-year-old woman was admitted to the emergency department with complaints of typical chest pain, cold sweat, and dyspnea of 24 hours’ duration. She had a history of hypertension, hyperlipidemia, and diabetes mellitus for many years. On admission, her electrocardiogram (ECG) revealed normal sinus rhythm and dynamic T inversion in the precordial leads. Her enzyme levels were normal. Transthoracic echocardiography showed a left ventricular ejection fraction of 60%, with mild mitral regurgitation...