Abstract
Coronary artery anomalies (CAAs) are rare congenital defects. The most frequent congenital anomaly is the origin of the left circumflex artery (LCX) from the right coronary sinus, followed by the common origin of the right coronary artery (RCA) and left anterior descending artery (LAD) from the right coronary sinus, as well as LAD originating from the right coronary sinus. The rarest anomaly is the left coronary artery or left main (LM) originating from the right coronary sinus. CAAs can occur with various anatomical features according to their origin and course. In this article, we will present four cases with congenital anomalies of the LM according to the above variations detected through coronary CT angiogram (CCTA) and coronary angiography. These cases involve an LM coronary artery originating from the right coronary sinus and pre-aortic course, retro-aortic course, LM originating from the sino-tubular junction above the left coronary sinus, and complete absence of LM. The incidence of these cases is rare, so their diagnosis is very important for patients' management and follow-up.