Acute coronary syndrome in an adult with anomalous origin of the left anterior descending coronary artery from the pulmonary trunk

Anomalous origin of the left anterior descending coronary artery is a very rare coronary vascular anomaly, especially in adults. We describe the case of a 45-year-old woman who presented with an acute coronary syndrome. Coronary angiography revealed an anomalous origin of the left anterior descending coronary artery from the main pulmonary trunk, with collateral filling from both the left circumflex and the right coronary artery. Treatment of choice of this coronary anomaly is usually surgical repair, while intense antithrombotic therapy should be considered, especially if the anomalous vessel is ectatic.