We describe the case of a patient with angiographic evidence in the right sinus of Valsalva of anomalous origin of LCx and common origin of LAD and RCA. This anomaly, which has not been reported previously, represents a further anatomic variation of the rare anomalous origins of all coronary arteries from right sinus of Valsalva. The symptoms in our patients were related exclusively to the atherosclerotic lesions in LCx and RCA and not to the anatomic anomalies. The patient underwent a bypass graft to LCx and RCA.