Anomalous Origin of the Left Main Coronary Artery from the Right Coronary Sinus

An elderly gentleman in his 60s presented with angina on exertion and dyspnea on exertion (NYHA class 3). On evaluation, he was found to have significant obstructive triple vessel disease. He also had an anomalous origin of the left main from the right coronary sinus with a long and tortuous left main coronary artery, which was seen to be running anterior to the pulmonary artery. He was treated with coronary artery bypass grafting with three grafts and re-implantation of the left main coronary artery to the left coronary sinus and was discharged with no postoperative complaints. This case report highlights a unique presentation of coronary artery anomaly in an elderly patient and underscores the importance of timely diagnosis and intervention.