Intercoronary connection is a rare variant of coronary anomalies with a direct continuity between two main coronary arteries. It may function as an alternative pathway to blood flow in compromised coronary circulation. 64 years old male presented with 4 weeks history of retro-sternal chest pain and shortness of breath; his risk factors were diabetes mellitus, hypertension and smoking. Physical examination was normal and he had no audible murmur; he had elevated cardiac enzymes; in echocardiography there was inferior wall hypokinesia, cardiac catheterization revealed complete occlusion of med right coronary artery and complete occlusion of the left main (LM) trunk. Blood flow to the entire myocardium came from large abnormal coronary connection between the right coronary artery ostium and the proximal left anterior descending artery. A smaller arterial communication maintained blood flow to the distal right coronary artery. Cardiac computed tomographic angiography confirmed the presence of a patent left main ostium followed by complete occlusion. This unusual anatomical variation has saved the life of the patient and allowed time for surgical revascularization. The patient underwent successful triple coronary artery bypass grafts with no postoperative difficulties or complications. On one-year follow-up, the patient is asymptomatic, fully active with no new ECG or echocardiography changes.
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