Anomalous left coronary artery

Selective coronary angiography of the left main coronary artery in the right anterior oblique (RAO, panel A) and left anterior oblique (LAO, panel B) views demonstrates a normal left anterior descending artery (LAD); however, the left circumflex artery (LCX) is absent. Angiography of the pulmonary artery in the RAO and LAO views (panels C and D) shows that the LCX arises from the junction of the junction of the main pulmonary artery and right pulmonary artery (RPA). This patient also had previous mitral valve replacement with a Bjork-Shiley valve (arrow).