Вальсальва

Very interested, I do not know this stuff.
Vasily,the first yudoman has ALCA no doubt about it,but can you see intramural or interarterial course of anomalous LCA in pictures, on the way to the left side from RSV?
The second case,a racer has the most common benign anomaly;LCx from RSV with retroaortic course.It is known as benign anomaly,but there are several cases with complications and one with sudden death,without any symptoms before.
This anomaly is very easy to diagnose by echo,easier than in coronarography))))

Anomalous LCx from RSV

Another patient,one can appreciate retroaortic course,but preatrialis/LA, between aorta and left atrium,relatively malignum route of LCx ciate retroaortic course,bet preatrialis/LA, between aorta and left atrium,relatively malignum route of LCx

The first patient is the most probably case of anomalous" Left atrial drainage of great cardiac vein"-> SEND
Normal course of GCV is along with LCx, rare occurrence of the arterial and venous flow in the same direction – in the coronary groove.

Citation.."The great cardiac vein begins at the cardiac apex and ascends along the anterior interventricular groove progressing to the base of the ventricles as the anterior inter ventricular vein. At the coronary groove it turns to the left to form the base of the triangle of "Brocq and Mouchet “with the two branches of the left coronary artery; the left anterior descending and the left circumflex arteries. The triangle is traversed by the diagonal branch of the LAD. The great cardiac vein runs along the coronary grove with the left circumflex to reach the posterior surface of the heart where it terminates by opening into the left extremity of the coronary sinus . . The opening of the great cardiac vein is guarded by the valve of Vieussens.

that 's the way it is

Left atrial drainage of great cardiac vein,respective CT image from an article and Echo image of mine.
The question is:Where is LAD prox?
Obscured by GCV?

I renew the post,here is the second possibility: LAD is obscured by GCV draining to RAA,Mr Gibreel CT image.
"Broken Triangle Broq and de Mouchet"
Very likely, so near an anomalous GCV and LAD,isn'it?