berrant right coronary artery (RCA) originating from the left sinus of Valsalva is an infrequent coronary anomaly reported to occur in 0.19% 1 and 0.17% 2 of patients undergoing diagnostic coronary angiography. Several reports have described an RCA originating from the left sinus of Valsalva and then coursing between the ascending aorta and the pulmonary trunk (PT), and this anomaly has been speculated as a cause of ischemia or sudden death in the absence of obstructive coronary artery disease.

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... 1-7 Three possibilities exist for the ischemic mechanism: the slit-like orifice of the anomalous coronary artery is compressed to the point of closure or near closure as the aorta dilates with exertion; the anomalous artery itself is compressed by the aorta and the PT as it courses between these 2 arteries, which dilate with exercise; or both of these factors. 3 The present study used 3-dimensional volume rendering (VR) images from electron-beam computed tomography (EBCT) to investigate the possible causes of ischemia from such an anomalous RCA, as well as investigated the course of the RCA. For these purposes, information on the shape of the orifice of the left main trunk, the spatial relationship of the lumen and the surface of the RCA, ascending aorta and the PT, and the angle of the bend of the bifurcation of the left main trunk (angle of the left main trunk to the RCA) would be useful.