Triple Origination of Left Coronary System from Right Coronary Sinus (with Prepulmonic, Intraseptal, and Retroaortic Courses): "Absent LM" and Split LAD
Special Features: The three anomalous vessels that arise from the right coronary sinus cross from right to left, as follows:
The anterior vessel, which is prepulmonic (with infundibular branches), terminates in a diagonal branch.
The intermediate vessel, which is intraseptal, is identified by the presence of a 1st septal branch and ends in the distal LAD.
The Cx, which is retroaortic, is shown on the RAO LV angiogram by a dot beneath the posterior cusp. The pulmonary infundibulum lies between branches 1 and 2.
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