RT Journal Article SR Electronic T1 Left main coronary artery atresia complicated by fistulae between the left anterior descending artery and the right ventricle JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP bcr-2018-226926 DO 10.1136/bcr-2018-226926 VO 11 IS 1 A1 Karen Watura A1 Adrian Pollentine YR 2018 UL http://casereports.bmj.com/content/11/1/bcr-2018-226926.abstract AB This case describes a 60-year-old man with congenital atresia of the left main coronary artery (LMCA), with fistulae between the left anterior descending artery (LAD) and the right ventricle (RV). This was detected at coronary CT. To our knowledge, this is the first reported case of congenital atresia of the LMCA in conjunction with fistulae between the LAD and RV. The patient remains asymptomatic at a 2-year follow-up. No treatment has been recommended. Coronary artery anomalies are rare. Although usually asymptomatic, they can present with symptoms varying from angina to sudden death. Identification and accurate description of coronary artery anomalies are vital in assessing the risk of associated adverse events.