First septal and diagonal arteries anomalously originating from the left main coronary artery: A very rare coincidence

A 47-year-old male who had been admitted to our emergency department was diagnosed with acute coronary syndrome. Coronary angiography revealed a true spider view in the left anterior oblique (LAO) caudal view; it included the first septal artery (FSA), left anterior descending artery, first diagonal artery, intermediate artery, and left circumflex artery all originating from the left main coronary artery (Fig. 1, Video 1). Stenosis (99%) was observed in the proximal LAD. Selective right coronary angiography revealed chronic total occlusion in the mid portion. In the LAO cranial view of the left coronary system, FSA appeared to supply collateral branches to the posterior descending artery (PDA), which was originating from the RCA (Video 1, 2)