Twin Circumflex Coronary Artery with anomalous origin from left main trunk — a rare variant

Coronary artery anomaly in form of dual origin of the circumflex artery is a rare anomaly. Though mostly described as having separate origin, both arising from left main coronary as twin circumflex artery itself has not been reported so far. Here we report a case of 57-year old male patient who had presented with ST elevation anterior wall myocardial infarction. His angiogram revealed left main trunk which was giving a left circumflex artery (LCx). On further coursing, left main trunk was trifurcating into left anterior descending artery (LAD), ramus intermedius and second left circumflex artery. Second circumflex branch was giving larger obtuse marginal branch while right coronary artery was smooth, non-dominant, and normal flowing artery. There was discrete eccentric stenosis with critical lesion in proximal LAD for which patient refused any intervention. Based on angiographic findings, it was diagnosed as a twin circumflex, both arising from left main trunk as one coming before the bifurcation while another after the bifurcation. An extensive search of literature and to the best of our knowledge, such type of anomaly is being reported for the first time.