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Anomalous origin of coronary arteries represents a rare anomaly affecting around 1% of the population out of which the aberrant origin of the left main stem is its rarest form. Clinically it may cause recurrent ischaemia, heart failure or sudden death. There are four anatomical variants of this malformation classified according to the course of the main stem. Coronary angiography is the golden standard to visualise both, the course and the lumen of the vessel. In certain cases its proximal course can be also visualised by other complementary methods like multislice beam computed tomography or magnetic resonance. In this case presenting with signs of heart failure and chest pain, we were able to show the presence of a single coronary artery originating from the right sinus of Valsalva with a main stem course anterior to the right ventricular outflow tract, using both visualisation methods, coronary angiography and 16-detector row gated CT angiography. CT allowed a clear visualisation of the angulated take-off of the single vessel trunk, probably involved in pathogenesis of the clinical picture.

Single coronary artery originating from the right sinus valsalva