Background: Coronary artery anomalies may be seen in 1-5% of coronary angiographies. Origin of the left coronary artery from right aortic cusp is a very rare anomaly and its incidence is about 0.15%. This anomaly could be presented by myocardial ischemia and even sudden cardiac death during exercise in young patients. For the diagnosis of coronary anomalies different diagnostic modalities such as, echocardiography, angiography and CT angiography can be helpful.
Cases: We report 3 cases with this anomaly and two of them did not have any lesion in their coronary arteries One of these patients had severe coronary artery disease and underwent coronary artery bypass graft surgery.
Conclusion: Although abnormal origin of left coronary artery from right aortic valsalva sinus is a rare anomaly, due to causing ischemic cardiac symptoms and the possibility of sudden cardiac death it is considered an important anomaly. For definite diagnosis of this anomaly coronary angiography and/or CT angiography is useful.