title: An unusual pattern of three major components of the cardiovascular system: multimodality imaging and review of the literature.
abstract: BACKGROUND
  Coronary artery anomalies are found in 0.4% to 1.4% of patients who undergo coronary angiography. Anomalous origin of left coronary artery from the right sinus of Valsava is the rarest, with a reported prevalence of 0.02 -0.03% according to angiographic studies.
  
  
  METHODS
  We present the rare case of a 42-year-old-man suffering from stable angina with unusual development of 3 major components of the cardiovascular system Coronary angiography revealed an anomalous origin of the left coronary artery from the ostium of the right coronary artery. Magnetic resonance angiography depicted an anomalous origin of the left common carotid artery from the innominate artery and an aneurysm of descending thoracic aorta. Coronary computed tomography angiography revealed the course of left coronary artery between aortic root and conus arteriosus at the level of the right ventricular outflow tract. In this report we attempt to highlight the rarity of this vascular anatomy.
  
  
  CONCLUSIONS
  Anomalous origins of the coronary arteries are rare, but may cause myocardial ischemia and sudden death. Thus, their reliable identification is a matter of paramount importance possibly evaluating the effects of therapeutic intervention. Newer imaging modalities improve the illumination of vascular system anatomy, shedding light to diagnostic dilemmas that come up in daily medical practice.
authors.affiliation: Department of Cardiology, 417 VA Hospital (NIMTS), 10-12 Monis Petraki st, Athens, Greece. dimitris.flessas@gmail.com
authors.forename: Dimitris
authors.initials: D
authors.lastname: Flessas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mamarelis
authors.forename: Vasilis
authors.initials: V
authors.lastname: Maniatis
authors.forename: George
authors.initials: G
authors.lastname: Souretis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Laschos
authors.forename: Christophoros
authors.initials: C
authors.lastname: Kotoulas
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Lazaridis
mesh_terms: D000328:Adult; D060050:Angina, Stable / Q000175:diagnosis / Q000473:pathology; D001013:Aorta, Thoracic / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis* / Q000473:pathology; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000473:pathology; D003952:Diagnostic Imaging; D006801:Humans; D008297:Male
references.citation: J Am Coll Cardiol. 2003 Jul 2;42(1):148-54
references.pmid: 12849675
references.citation: Tex Heart Inst J. 2006;33(2):171-9
references.pmid: 16878619
references.citation: J Am Coll Cardiol. 2000 May;35(6):1493-501
references.pmid: 10807452
references.citation: Coron Artery Dis. 2008 May;19(3):203-9
references.pmid: 18418238
references.citation: Cathet Cardiovasc Diagn. 1990 Sep;21(1):28-40
references.pmid: 2208265
references.citation: J Am Coll Cardiol. 1989 Mar 1;13(3):531-7
references.pmid: 2918156
references.citation: Radiology. 1977 Jan;122(1):47-52
references.pmid: 830353
references.citation: Circulation. 2007 Mar 13;115(10):1296-305
references.pmid: 17353457
references.citation: J Invasive Cardiol. 2005 Jan;17(1):56-8
references.pmid: 15640543