The American Journal of Cardiology MARCH 13e16, 2014 10 IN AND C The incidence of the coronary artery anomalies ranges between 0.3-1%. Although coronary artery anomalies are present at birth, relatively few of them become symptomatic during childhood. The majority of anomalies are identified as incidental findings during coronary arteriography or at autopsy. However, some may become evident with angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure and even, sudden death. In this study, rate and pattern of congenital coronary artery anomalies in adult patients undergoing coronary angiography (CA) in a high volume tertiary medical center were reported. Among the 52 887 coronary angiographies performed between 2003 and 2009. 555 (390 male, 165 female) cases of coronary artery anomalies (1.05%) were identified. The mean age of patients with coronary artery anomaly was 52 13 years. Detailed description of coronary artery anomalies in our CA series is presented in Table 1. Atherosclerotic coronary artery disease accompanied to congenital coronary anomaly in (47.6 %) of cases. Myocardial bridges were the most common coronary artery anomaly and detected in 297 (53.5 %) patients. In 195 of cases (35%) anomalous origin or anomalous course of coronary arteries was present. Among them, anomalous origin of circumflex artery from the right coronary sinus was the most common form (n1⁄486, 15.5% of all cases). The second most common pattern regarding anomalous origin was the origin of right coronary artery from the left coronary sinus (n1⁄434, 6.1% of all cases). The rate of separate ostia of the left circumflex and left anterior descending coronary arteries from left coronary sinus or in other words, absence of left main coronary artery in our series was 2.5 % (n1⁄414). Although the absence of left main coronary artery is thought to be higher, this anomaly might not be specified by operator due to its benign course or inadequate imaging during procedure. Coronary artery fistulae were detected in 57 (10.2%) cases and congenital coronary aneurysm was present in 6 (1.1%) cases. The recognition of coronary artery anomalies shortens the duration of coronary angiography and mitigates the radiation exposure for both the operators and the patients. Also, it is important to know if there is any anomaly in origin or in course of coronary arteries before cardiac surgery to avoid complications.