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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). Most coronary origination anomalies are clinically silent and are incidentally encountered either via coronary angiography or computerized tomography. However, they can prove crucial when it comes to providing collateral circulation to the other main arteries that were unable to supply adequate blood flow to their pertinent territories. Moreover, anomalous FSAs may play a pivotal role in providing collateral blood flow in severe coronary arterial diseases. To our knowledge, this is the first case report describing the co-existence of the first septal and diagonal arteries anomalously originating from the left main coronary artery.

A Very Rare Coincidence of First Septal and Diagonal Arteries Originating Anomalously from the Left Main Coronary Artery