S Case Re Port Right Cor O Nary Ar Tery Arising from the Left Main Stem with Dy Namic Com Pres Sion by Great Ves Sels

and the re ported angiographic in ci dence was 0.044%. Sin gle cor o nary ar tery with anom a lous or i gin of the right cor o nary ar tery (RCA) from the left main (LM) stem is even rarer and was once thought to be a be nign con di tion. As the anom a lous RCA orig i nates from the LM stem, it can pass an te rior to the pul mo nary trunk, pos te rior to the aor tic root, or be tween these two great ves sels. Nev er the less, as the prox i mal RCA courses be tween the aorta and pul mo nary trunk, the ad ja cent great ves sels can pinch it, re sult ing in dy namic blood flow com pro mise. Se ri ous clin i cal events in clud ing an gina pectoris, acute myo car dial in farc tion, syn cope and sud den death have been re ported in as so ci a tion with this anom aly. With grow ing aware ness of its pathophysiology, the op ti mal ap proach has been switched from con ser va tive med i cal treat ment to ag gres sive sur gi cal in ter ven tion. Herein, we re port a 68year-old fe male with anom a lous or i gin of the RCA from the LM. Cor o nary angiography showed the cor o nary blood flow was dy nam i cally com pro mised by aor tic root and pul mo nary trunk in the sys tolic phase.