A rare coronary anomaly: all main coronary arteries originating from right sinus of Valsalva with separate ostium

All coronary arteries originating from separate ostia in the right sinus of Valsalva is a very rare coronary artery anomaly. In particular, the inter-arterial course of the coronary arteries may lead to malignant clinical outcomes. In the literature, such coronary artery anomaly have been reported to cause myocardial ischaemia and sudden cardiac death. In our case, coronary angiogram was performed on a patient presenting with unstable angina pectoris, and the left anterior descending artery, circumflex artery and right coronary artery were found to originate from separate ostia in the aorta. To better clarify the course of the coronary arteries, coronary computed tomography angiography was performed and all three coronary arteries were determined to originate from separate ostia in the right sinus of Valsalva. The left anterior descending artery was found to pass through the inter-atrial septum in coronary computed tomography angiography. In our presentation, the clinical data about the case where three coronary arteries originated from separate ostia in the right sinus of Valsalva have been presented along with the coronary angiography and coronary computed tomography angiography images in the light of literature.