Presentation
Chest pain.
Patient Data
Normal right coronary artery origin. The left main coronary arises from the right coronary artery with a "benign" retroaortic course. No obstructive disease. Right coronary artery dominance.
Illustration of normal, "malignant" and "benign" left coronary artery origin/course.
Case Discussion
Anomalous coronary arteries may have a so-called benign (asymptomatic without risk of decreased blood flow) or a malignant (potentially symptomatic with risk of decreased blood flow, ischemia, and sudden death) course. In most cases, a vessel running between the aorta and the pulmonary artery has a malignant course. Vessels running in front of the pulmonary artery (pre-pulmonic) or behind the aorta (retroaortic) are considered to have a benign course.
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