A Rare Case of a Type IV Dual Left Anterior Descending Artery and Ectopic Left Anterior Descending and Circumflex Arteries Requiring Surgery

Abstract

Congenital anomalous coronary arteries (CACAs) comprise an important variant of the coronary vasculature. They are benign in the vast majority of cases, whereas a small minority may be affected by serious consequences such as myocardial infarction, arrhythmia, cardiac arrest, and even death. We herein describe a 62-year-old man with sudden and severe substernal chest pain; Q waves in electrocardiographic leads II, III, and aVF; and positive serum troponin I enzyme. Left heart cardiac catheterization revealed triple coronary vessel disease with a 60% to 70% occlusion in the left main coronary artery (LMCA). The left anterior descending (LAD) and the left circumflex artery arose from the ostium of the right coronary artery. Additionally, a rudimentary type IV dual LAD originated from the LMCA. A coronary artery bypass graft surgery was performed using a left internal mammary artery graft for the LAD and a saphenous vein graft for the diagonal branches (I & II) of the LAD and the posterior descending artery. The patient was discharged after an uneventful 1-week hospital course.

Dual Left Anterior Descending Artery: Clinical Overview and Interventional Management

“…Understanding the different dual LAD types is crucial to the revascularization of the correct arterial system and the prevention of inappropriate arteriotomy. 17 The anterior LV wall and the septum may receive their blood supply from the 2 separate arteries; therefore, grafts to both vessels may be required if both the short and long LADs are significantly stenosed. 12 , 16 Furthermore, different anatomic characteristics at regular coronary angiography might be mistaken for mid-LAD occlusion since the extra artery cannot be seen, especially when the long LAD originates from the right coronary cusp.…”

Surgical Revascularization of the Dual Left Anterior Descending Coronary Artery; A Case Report

“…In various coronary angiographic studies, the reported incidence of dual LAD is 0.64-1.3%. 1,2 Accurate localization of coronaries in CABG surgery is imperative for identification and revascularization of the coronary arteries.…”