Single right coronary ostium with anterior course of the left coronary artery (LAD)

Single coronary artery is a rare congenital anomaly with a quoted incidence of 0.024% to 0.06% (1), and may be associated with sudden cardiac death after exercise and angina. We present the case of a single coronary artery originating from a single ostium in the right sinus of Valsalva with an anomalous course of the left coronary artery (LCA) anterior to the pulmonary trunk, and unusual distal anastomosis at the junction of the mid and distal left anterior descending artery (LAD) with occlusion of the proximal circumflex (Cx) artery.