The document discusses various coronary artery anomalies that can be identified through angiography. It presents several case examples of different anomalous coronary artery origins and courses, including the left main coronary artery arising from the right coronary sinus and coursing between the aorta and pulmonary artery, which is the highest risk type. It also discusses anomalies like an anomalous right coronary artery taking off from the left coronary sinus. The cases are demonstrated through angiographic images.

1. Coronary Artery Anomalies: Angiographic Recognition of High Risk Richard E. Browne, MD John D. Symanski, MD

10. Coronary Artery Anomalies Pete Maravich (June 22, 1947 – January 5, 1988)

11. Sudden Cardiac Death in Athletes

12. Coronary Artery Anomalies Demonstrated by Echocardiography

14. RAO RAO

15. RAO

16. Myocardial Bridging Tunneled LAD

18. M ö hlenkamp et al. Circulation 2002;106:2616-22.

19. M ö hlenkamp et al. Circulation 2002;106:2616-22.

20. High Takeoff Coronary Ostia Above Sinuses of Valsalva

21. LAD and CFX Arising from Separate Ostia Kimbiris D., et al. Circulation 58:606-15, 1978 .

22. Retro-Aortic Left Circumflex Kimbiris D., et al. Circulation 58:606-15, 1978 .

23. Retro-Aortic Left Circumflex

24. Absent Circumflex Super-dominant RCA

25. Absent Right Coronary Super-dominant Circumflex

26. Left Coronary Arising From PA Bland-White-Garland Syndrome Blood flows from the RCA via collaterals to the left coronary artery, and then into the pulmonary artery.

27. Anomalous Coronary Arteries by Electron Beam Angiography Circulation. May 27, 2003;107:2630

28. Anomalous RCA Takeoff From Left Coronary Sinus Kimbiris D., et al. Circulation 58:606-15, 1978 . *The most common, potentially serious coronary anomaly, accounting for 8.1% of serious coronary anomalies (25% incidence of sudden cardiac death).

29. Anterior Course of RCA Arising From Left Coronary Sinus

30. Anomalous Right Coronary Artery RCA Arising From Left Coronary Sinus

31. Coronary Artery Anomalies Magnetic Resonance Imaging

33. Left Main from Right Sinus Anterior Course The left main trunk arises ectopically from the right sinus of Valsalva and passes epicardially across the RV outflow tract.

34. Left Main from Right Sinus Anterior Course

35. Anomalous Left Coronaries Retro-Aortic Circumflex, Anterior LAD The LAD and circumflex branches arise from the right sinus of Valsalva. The LAD passes epicardially across the RVOT, and the CFX passes behind the aorta.

36. Anomalous Left Main Retro-Aortic The left main trunk originates from the right sinus of Valsalva and passes behind the aorta before dividing into the LAD and CFX branches.

37. Retro-Aortic Course of Left Main Kimbiris D., et al. Circulation 58:606-15, 1978 . *Dot-sign posterior to aortic root

38. Anomalous Left Main Inter-Arterial The left main trunk arises ectopically from the right sinus of Valsalva and passes between the aorta and pulmonary artery.

39. Inter-arterial Course of Left Main Arising From Right Coronary Sinus Kimbiris D., et al. Circulation 58:606-15, 1978 . *Dot sign anterior to aortic root

42. Left Main from Right Sinus Septal Course The left main trunk originates from the right sinus of Valsalva and passes intramuscularly to the septum before reaching an epicardial position.

43. Left Main from Right Sinus Septal Course

44. Anomalous Left Main Angiographic Features of Subtypes Kern, MJ. The Cardiac Catheterization Handbook, 1991