During the last 25 years many differing types of anomalies of origin of one or more coronary arteries have been observed at necropsy. These various anomalies as observed in adulthood (greater than age 15 years) were examined. The most common major anomaly is origin of one or more coronary arteries from the pulmonary trunk and origin of one or more coronary arteries from the aorta. This anomaly was encountered in 5 patients, only one of whom reached adulthood (44 years). Origin of 1 or 2 coronary arteries from the pulmonary trunk without origin of a coronary artery from the aorta was encountered once, in a newborn. This anomaly has not been observed in adults. The third major category was the anomalous origin of one or more coronary arteries from the aorta without origin of a coronary artery from the pulmonary trunk. The most common of these anomalies is origin of both left main and right coronary arteries from the right aortic sinus. This anomaly is a relatively common cause of sudden death during childhood and this anomaly was encountered in 5 children. The next major anomaly was origin of both left main and right coronary arteries from the left aortic sinus. This anomaly was encountered in 16 individuals at necropsy, all of whom, were adults. In contrast to previous studies of this anomaly, it was shown that it can be a cause of sudden unexpected death. The most common of the anomalies of origin is both right and left circumflex coronary arteries from the right aortic sinus (or origin of the left circumflex from the right coronary artery) and of left anterior descending coronary artery from the left aortic sinus. This anomaly was described initially in 1933.
