Circumaortic Configuration of the Left Coronary Arteries

Coronary artery anomalies can be divided into anomalies of origin, course, or terminations of any of the epicardial coronary arteries. Coexistence of anomalous origin of the left circumflex artery with retroaortic course and anomalous origin of left anterior descending artery arising from the right coronary sinus with interarterial course is an exceedingly rare anatomical configuration. In the presence of this anomaly, conventional catheter angiography is challenging due to technical reasons and may lead to an inadvertent misdiagnosis of significant stenosis or occlusion of the coronary artery. This case highlights the importance of coronary computed tomography angiography in identifying a rare coronary artery anomaly and providing guidance for future endovascular or surgical procedures.