Origin of three coronary arteries from the right sinus; ramus intermedius from the left sinus and hybrid distribution

Abstract

A 72-year-old hypertensive man with diabetes. had a previously undiagnosed pattern of coronary artery. distribution: the ramus intermedius from the left sinus, and the separate origin of the left anterior descending artery, left circumflex artery and right coronary artery from the right sinus. A unique form of branching, a hybrid distribution, was also noted: the left anterior descending artery giving off a right ventricular branch and septals arising from the ramus. No intervention was planned due to the minimal disease observed with angiography and the absence of an interarterial course.