It is uncommon for the left anterior descending coronary artery to arise from the contralateral Valsalva sinus, and more of a rarity to see coexistent left main coronary artery anomaly. Our patient reported normal daily physical activity and denied further evaluation (stress test, scintigraphy) or cardiothoracic consultation. She continues to be symptom free at 1-month follow-up.
Keywords: ACAOS; anomalous coronary artery; coronary artery atresia.