Percutaneous coronary intervention in an anomalously arising totally occluded circumflex coronary artery

Congenital coronary anomalies are present in approximately 1% of the patients referred to cardiac catheterization. The present case describes a successful percutaneous coronary intervention in totally occluded left circumflex coronary artery (LCx) with an anomalous origin from right sinus of Valsalva. To the best of our knowledge this is the first case presented of successful recanalization of a chronic total occlusion in an anomalously arising LCx. The case highlights the feasibility of such a challenging procedure on the basis of the knowledge of coronary anatomy and the selection of appropriate guiding catheters and coronary wires.