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Anomalous Left Main Coronary Artery From Right Coronary Cusp

Anomalous origin of the left main coronary artery is a rare clinical entity that can present with symptoms across the clinical gamut, from asymptomatic to chest pain and possibly even sudden death. The clinical syndrome varies depending on the course of the aberrant left main. The anterior course where the artery runs between the aorta and the pulmonary artery can lead to compression of the left main, resulting in ischemia and possibly sudden death. In this article, the authors describe a case of a left main arising from the right coronary cusp that took a posterior course. There was a high-grade, proximal left anterior descending artery lesion that was treated with percutaneous intervention after defining the course of the aberrant left main.