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Dual left anterior descending artery (LAD) is a rare congenital coronary artery anomaly with a prevalence of approximately 1% in the general population. To date, 10 types of dual LAD artery anomalies have been reported. Among these, type 4 is one of the rarest. Knowledge and recognition of the dual LAD artery are important for correct diagnosis and planning of coronary bypass surgery and percutaneous coronary intervention. We report a case of a 59-year-old male with type 4 dual LAD artery who presented with dyspepsia and sweating for several months and had approximately 50%–70% stenosis in a major diagonal branch off the short LAD artery. more...

A dual left anterior descending artery (LAD) is not an uncommon anomaly of the coronary arterial system. The earlier classifications by various authors lacked standardization and uniformity and are too complex for clinical usage. Therefore, a new classification in the form of coding system is proposed to facilitate the identification and reporting of the anomaly by the cardiologists to maintain uniformity in reporting, which aids in adequate planning of the revascularization strategies in patients with symptomatic coronary artery disease involving the dual LAD system. [ABSTRACT FROM AUTHOR] more...

Anomalous origin of left anterior descending artery (LAD) from pulmonary artery (ALADCAPA) with dual LAD from left sinus is an extremely rare coronary anomaly. The diagnostic challenge lies in differentiating this from a coronary cameral fistula. Surgical reimplantation of the anomalous LAD is recommended to prevent the risk of myocardial ischaemia and ventricular arrhythmias. [ABSTRACT FROM AUTHOR] more...

Duplication of the left anterior descending artery is an uncommon coronary anomaly. Since no proper classification has been established after the initial description and numerical classification by Spindola-Franco et al., many newer numbers have evolved with many overlapping and unclassified variants described in the literature. Identification and reasonable management strategies for dual left anterior descending artery (LAD) are crucial in preventing the long-term disastrous consequences of inadequate revascularization. Clinicians and diagnosticians should be aware of this specific angiographic-based congenital coronary abnormality of the LAD. We, therefore, sought a new, reasonable classification of the dual LAD system, which would clarify this ambiguity, which also has therapeutic implications. [ABSTRACT FROM AUTHOR] more...

Abstract Background Dual left anterior descending (LAD) artery or duplication of LAD is a rarely reported coronary anomaly, consisting of two branches supplying the usual distribution of the LAD. Type IV dual LAD, in which a short LAD arises from the left main coronary artery and a long LAD arises from the right coronary artery is remarkably rare, and has not been reported in a Bangladeshi subject. Case presentation We describe the case of a 70-year old Bangladeshi male who presented with breathlessness in the background of a prior inferior myocardial infarction. Coronary angiography revealed an anomalous dual LAD. The short LAD which arose from the left main coronary artery gave off the first septal branch and terminated after giving off a large diagonal branch which continued further down towards the apex. The long LAD arose from the proximal right coronary artery and after traversing a distance, arrived at the interventricular septum, terminating at the apex after giving off diagonal branches. The right coronary artery was totally occluded from its early mid part and well-collateralized with retrograde flow from the left system. Conclusion We describe a case with unique variation of dual LAD type IV, which has previously not been described in a Bangladeshi subject thus far. Coronary angiography is vital to determine this coronary anomaly, which is usually detected incidentally on routine angiography for chest pain, sometimes with involvement of significant lesion of other coronary arteries, as in this case. more...

Dual anterior interventricular artery is a rare type of CHD. We reported a fifteen-year-old girl who underwent CT angiography that demonstrated one anterior interventricular artery from aorta and another from pulmonary artery. more...

Objectives: The purpose of this study was to identify the prevalence of dual left anterior descending artery and define the morphological features using coronary computed tomography angiography in order to raise awareness of dual left anterior descending artery among radiologists. Materials and methods: The radiologic reports of 1912 patients who underwent coronary computed tomography angiography at our institution were searched retrospectively for the presence of dual left anterior descending artery. Computed tomography images of patients with dual left anterior descending artery were then reviewed, and the morphological features of dual left anterior descending artery were evaluated. Results: Dual left anterior descending artery was identified in 1.3% of the patients in this study population. Type 1 dual left anterior descending artery was the most common subtype (76%). Four additional cases that were not classified before were also detected. Conclusion: Dual left anterior descending artery has a variety of subtypes reported mostly as odd cases, and gaining diagnostic awareness of dual left anterior descending artery is more critical, rather than listing and counting the subtypes. With the widespread use of coronary computed tomography angiography, it has become essential for radiologists to have knowledge about dual left anterior descending artery, as it is vital, especially for surgical planning. [ABSTRACT FROM AUTHOR] more...

A dual left anterior descending artery with an anomalous origin of the left coronary artery from the pulmonary artery is an extremely rare coronary artery anomaly, with only one case known previously reported. However, that study presented coronary anatomical findings with images and little is known regarding patient outcome following surgical management for this unique condition. We present here the first case report of an affected patient, who underwent off-pump coronary artery bypass grafting and ligation of the coronary anomaly, as well as postoperative course details. [ABSTRACT FROM AUTHOR] more...

Background: Dual left anterior descending (LAD) artery or duplication of LAD is a rarely reported coronary anomaly, consisting of two branches supplying the usual distribution of the LAD. Type IV dual LAD, in which a short LAD arises from the left main coronary artery and a long LAD arises from the right coronary artery is remarkably rare, and has not been reported in a Bangladeshi subject. Case presentation: We describe the case of a 70-year old Bangladeshi male who presented with breathlessness in the background of a prior inferior myocardial infarction. Coronary angiography revealed an anomalous dual LAD. The short LAD which arose from the left main coronary artery gave off the first septal branch and terminated after giving off a large diagonal branch which continued further down towards the apex. The long LAD arose from the proximal right coronary artery and after traversing a distance, arrived at the interventricular septum, terminating at the apex after giving off diagonal branches. The right coronary artery was totally occluded from its early mid part and wellcollateralized with retrograde flow from the left system. Conclusion: We describe a case with unique variation of dual LAD type IV, which has previously not been described in a Bangladeshi subject thus far. Coronary angiography is vital to determine this coronary anomaly, which is usually detected incidentally on routine angiography for chest pain, sometimes with involvement of significant lesion of other coronary arteries, as in this case. [ABSTRACT FROM AUTHOR] more...

Dual left anterior descending artery is a rare coronary artery anomaly showing two left anterior descending arteries. Short anterior descending artery usually arises from the left coronary artery, while long anterior descending artery has anomalous origin and course. Dual left anterior descending artery with origin of long anterior descending artery from the pulmonary artery (ALCAPA) is a very rare coronary artery anomaly which has not been reported previously in the literature. We present the computed tomography coronary angiographic findings of this rare case in a young female patient who presented with atypical chest pain. [ABSTRACT FROM AUTHOR] more...

We report a case of a 10‐month‐old cyanotic child with tetralogy of Fallot showing intrapulmonary invagination of right subclavian artery and presence of dual left anterior descending artery with the high take‐off of the right coronary artery. This case highlights the role of computed tomography angiography in depicting vascular anatomy (arch vessels and coronary arteries) in patients with congenital heart diseases and in the planning of surgical management. [ABSTRACT FROM AUTHOR] more...

Major aortopulmonary collaterals (APCs) are more common with tetralogy of Fallot (TOF) with pulmonary atresia. Collateral arteries, when present, arise most commonly from the descending thoracic aorta, less commonly from the subclavian arteries, and rarely from the abdominal aorta or its branches or from the coronary arteries. Collaterals arising from the coronary arteries can cause myocardial ischemia due to coronary steal phenomenon. They can be addressed either by endovascular interventions like coiling or surgical ligation during the intracardiac repair. Coronary anomalies are seen in 5%-7% of TOF patients. In approximately 4% of TOF patients, the left anterior descending artery (LAD) or an accessory LAD takes origin from the right coronary artery or right coronary sinus and crosses the right ventricular outflow tract in its course toward the left ventricle. Presence of such anomalous coronary anatomy poses certain challenges during intracardiac repair of TOF. more...

Dual left anterior descending (LAD) artery is an infrequent coronary anomaly classified into six types. Short LAD arising from left main coronary artery (LMCA) and long LAD sourcing from proximal right coronary artery comprise Type IV dual LAD. We reported anomalous origin of circumflex artery (Cx) with reverse Type IV LAD including short LAD arising from right coronary sinus and long LAD originated form LMCA. more...

Abstract: A 65-year-old man was admitted into our hospital because of the detailed examination for abnormal Q waves in inferior leads on an electrocardiogram. Coronary angiography and 320-row area detector computed tomography (ADCT) revealed “dual left anterior descending artery (LAD)”, which was a rare anomaly of the LAD and chronic total occlusion (CTO) at segment 2 of the right coronary artery (RCA). The course of the anomalous LAD arising from the proximal portion of the RCA was specifically identified between aortic root and right ventricular outflow tract (RVOT) by 320-row ADCT. The anomalous LAD had potential risk of myocardial ischemia because of the compression from aortic root and RVOT during exercise. We performed technetium myocardial perfusion scintigram to evaluate exercise-induced ischemia in the territory of the anomalous LAD and to decide therapeutic strategies including coronary artery bypass grafting surgery to the vessel. The scintigram revealed no exercise-induced ischemia in anteroseptal wall and a constant perfusion defect in posteroinferior wall of the left ventricle. Thus, we decided to treat the patient with pharmacological treatment in the outpatient setting. This report suggests that it is important to recognize the variants of coronary arteries for optimal treatment. [Copyright &y& Elsevier] more...

The anomalous origin of the left circumflex (LCX) artery from the right coronary sinus is a relatively rare condition. A 'double' left anterior descending (LAD) artery is probably the rarest of coronary artery anomalies. We present a case of acute myocardial infarction with a clot and a critical distal stenosis in the left main stem (LMS) supplying a dual LAD and an aberrant origin of the LCX., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Malik et al.) more...

Background: Coronary artery anomalies (CAAs) are rare disorders of coronary anatomy with varied clinical presentations. There are widespread geographic variations in incidence and patterns of these anomalies, with limited data from North Indian population. We performed a retrospective study to evaluate the incidence, characteristics and atherosclerotic involvement of CAAs in adult population undergoing catheter coronary angiography., Methods: Serial coronary angiographies performed at our institution over a period of 2.5 years (from January 2017 to June 2019) were retrospectively analyzed. We identified patients with anomalous coronaries and studied their clinical characteristics and angiographic profiles., Results: Among 3,233 coronary angiograms analyzed, CAAs were found in 99 patients with an incidence of 3.06%. Mean age of the patients was 56.2 ± 12.9 years (range: 20 - 86 years), with 74.75% being males and 25.25% females. Split right coronary artery (RCA) was the most common coronary anomaly, being seen in 27 patients; with an angiographic incidence of 0.84%. Dual left anterior descending artery (LAD) was the second most common anomaly and was seen in 22 cases with an angiographic incidence of 0.68%. Absent left main trunk was noted in 14 patients (0.43%). Ectopic origin of RCA from left sinus was seen in 12 patients (0.37%), while ectopic origin of RCA from ascending aorta was seen in four patients (0.12%). Ectopic origin of left circumflex artery (LCX) from right sinus or RCA was noted in 13 patients (0.40%). One patient (0.03%) had a superdominant LAD supplying the posterior descending artery (PDA). Coronary artery fistulae were seen in six patients (0.18%). Significant coronary artery disease (CAD) was seen in 89 of 268 (33.21%) normal vessels, whereas it was seen in 56 of 114 (49.12%) of anomalous vessels. This difference was statistically significant (P = 0.003)., Conclusions: The incidence of CAAs in our study was slightly higher than many of the previous angiographic series. The patterns of coronary anomalies in our study were different from most of the previous studies. Our study had higher incidence of atherosclerotic involvement of anomalous vessels as compared to normal vessels., Competing Interests: None to declare., (Copyright 2019, Sidhu et al.) more...

Dual left anterior descending (LAD) artery is an infrequent coronary anomaly classified into six types. Short LAD arising from left main coronary artery (LMCA) and long LAD sourcing from proximal right coronary artery comprise Type IV dual LAD. We reported anomalous origin of circumflex artery (Cx) with reverse Type IV LAD including short LAD arising from right coronary sinus and long LAD originated form LMCA. [ABSTRACT FROM AUTHOR] more...

Abstract: A 58-year-old woman came to our hospital because of chest pain. Multi-detector computed tomography (MDCT) showed type V dual left anterior descending artery (LAD) and a 90% stenosis in segment 1 of the right coronary artery. Two days after examination, she was admitted to our hospital because of recurrent chest pain. She was diagnosed with acute myocardial infarction. Coronary angiography showed a 99% stenosis in segment 1 and a dual LAD. She received successful percutaneous coronary intervention (PCI) to segment 1 with a bare metal stent. Type V dual LAD is a rare and complicated coronary anomaly with the short LAD originating from the left sinus of valsalva and the long LAD originating from the right sinus of valsalva. Identifying anatomy of the coronary artery is important when making a strategy for PCI. In types IV–VI dual LAD, the anatomic features can be misinterpreted at coronary angiography. MDCT was useful in understanding the anomaly of dual LAD and performing PCI in the present case. [Copyright &y& Elsevier] more...