Multiple variants and anomalies in the coronary vasculature have been reported. Some variants, particularly those with duplication, can be advantageous, many are insignificant and some are ultimately lethal. Many of these variants and anomalies are not identified until imaged or post-mortem. A novel bilateral bifid variation of the coronary arteries was observed in 49-year-old male cadaver. The respective origins were associated with the left and right aortic cusps from single ostia. Immediate bifurcation followed on either side. A right sided accessory branch supplied the pulmonary trunk and right ventricle. A more standard branch continued to form the posterior interventricular artery. The left sided variation demonstrated a solitary circumflex artery (towards the posterior interventricular septum) and, left marginal and anterior interventricular branches shortly after bifurcation. This case may be beneficial in surviving adverse cardiac events, particularly those associated with lifestyle. They also present a ‘double’ challenge for clinicians.

Multiple variants and anomalies in the coronary vasculature have been reported. Some variants, particularly those with duplication, can be advantageous, many are insignificant and some are ultimately lethal. Many of these variants and anomalies are not identified until imaged or post-mortem. A novel bilateral bifid variation of the coronary arteries was observed in 49-year-old male cadaver. The respective origins were associated with the left and right aortic cusps from single ostia. Immediate bifurcation followed on either side. A right sided accessory branch supplied the pulmonary trunk and right ventricle. A more standard branch continued to form the posterior interventricular artery. The left sided variation demonstrated a solitary circumflex artery (towards the posterior interventricular septum) and, left marginal and anterior interventricular branches shortly after bifurcation. This case may be beneficial in surviving adverse cardiac events, particularly those associated with lifestyle. They also present a ‘double’ challenge for clinicians.