Rare variant of an anomalous left coronary artery: arising from the distal continuation of a single right coronary artery

We report an interesting case of single right coronary artery arising from the right sinus of Valsalva and continuing distally as a rare anomalous left coronary artery. Over the 7-year course of our clinical follow-up, the right coronary artery manifested severe, progressive atherosclerotic disease in multiple sites, which lesions were successfully stented. We hypothesize that the disease process in the right coronary artery was accelerated by shear stress in association with that vessel's need to carry the entire burden of the coronary circulation.