Coronary artery anomaly occurs in less than 1% of the general population. It is frequently found in association with other major congenital cardiac defects. This letter focuses on isolated coronary artery anomalies (i.e., in the absence of other major congenital cardiac defects). In adults, the clinical interest in coronary anomalies relates to their occasional association with sudden death, myocardial ischemia, congestive heart failure, or endocarditic. In addition, presence of coronary artery anomalies may, at times, create challenges during coronary angiography, percutaneous coronary interventions and coronary artery bypass surgery1-4.