Two circumflex arteries originating from both right and left coronary sinuses of Valsalva

A 75-year-old woman with a history of chest discomfort was referred to our clinic. Following physical examination and initial tests, a diagnostic coronary arteriography was planned. Left coronary arteriography revealed a normal left main coronary artery (LMCA) originating from the left sinus of Valsalva. The LMCA was branching into the left anterior descending (LAD) and left circumflex (Cx) arteries (Fig. 1). When the right coronary ostium was cannulated, another Cx artery was noticed in addition to a right coronary artery (RCA) (Fig. 2). Most of the cases with anomalous origin of the Cx artery, the initial course is posterior to the aorta. An interarterial course of a Cx artery is a very rare condition. In this case, mild ectasia or interarterial course might be responsible for her symptoms. A multislice computed tomography was planned to show the course, but she refused to take additional radiation. In cases of double Cx artery, origination of the Cx artery as a proximal branch of the RCA or separate branch from right sinus of Valsalva has been previously reported [1]. This case illustrates dual Cx artery with a common ostium with RCA.

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