Background: Anomalous origin of either the left main coronary artery (LMCA) or right coronary artery (RCA) from the aorta and their course between the aorta
and pulmonary trunk is rare with prevalence about 5% and mostly considered as a fatal coronary artery anomaly.
Case Summary: We reported two cases which represented one type of abnormal developmental disorder affecting coronary anatomy, with combined two rare
malformations affecting coronary circulation in adult age. Also clarified how new technology through cardiac MRI and CT coronary angiography gave us excellent
gross anatomical details to complete the diagnosis and management.
Conclusion: Our documented rare cases showed a combination of two coronary anomalies, firstly abnormal origin of LAD and LCX from right coronary sinus and
simultaneously the abnormal malignant course of LAD between ascending aorta and pulmonary trunk. Anomalous origins of the left coronary artery is a rare case
that carry a higher risk of sudden cardiac death,so need meticulous care and mangment.