Anomalous origin of the left anterior descending artery from the pulmonary artery

The origin of the left anterior descending coronary artery (LAD) from the pulmonary artery is a rare cause of myocardial ischaemia in adults. A 26-year-old man who presented with anterior wall myocardial infarction underwent coronary angiogram, which showed a large right coronary artery (RCA) arising from the right sinus of Valsalva (RSV) and retrogradely filling the LAD that drained into the main pulmonary artery (MPA) (panels A and B, movie 1, available online only). The left circumflex coronary artery (LCX) originated from the RSV and followed a retroaortic course into the left atrioventricular groove. The …