Left main disease associated with an anomalous left anterior descending artery.

Background: Coronary artery anomalies are very rare. Recognizing these anomalies are clinically relevant as they can mimic symptoms of coronary artery disease, and sporadic cases of sudden death have been described in these patients.

Method: This report describes a 55-year-old patient with left main disease and an anomalous left anterior descending artery arising from anterior coronary sinus who presented with palpitations.

Result: Patient underwent coronary artery bypass grafting with left internal mammary artery to the ramus intermedius with cardiopulmonary bypass using antegrade blood cardioplegia. The anomalous left anterior descending artery was crossing the right ventricular outflow tract and running on the interventricular groove.

Conclusion: The diagnosis and management of coronary artery anomalies is the subject of this review.