Dual left anterior descending coronary artery: Angiographic description of important variants and surgical implications

Spindola‐Franco, Hugo; Grose, Richard; Solomon, Norman

doi:10.1016/0002-8703(83)90363-0

Cited by 198 publications

(239 citation statements)

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“…The prevalence in our study was similar to previously reported prevalence in CCTA studies and higher as compared to CCA studies. This is the first study on CCTA and CAA to be reported from Pakistan and our findings are comparable with previous reported studies [5,[7][8][9][10]17,19,20]. The main limitation of this study is its retrospective design.…”

Section: Discussionsupporting

confidence: 82%

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The prevalence of coronary artery anomalies on CT scan; Experience from a tertiary care center in Pakistan (RCD code: I-1C.1)

Hussain

Sultan

Jamil

2017

Journal of Rare Cardiovascular Diseases

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Objectives: This study is an effort to bridge the gap regarding the data of prevalence of coronary anomalies in South Asian countries by utilizing coronary computed tomography angiography (CCTA). Methods: This is a cross sectional, descriptive study done at Aga Khan University Hospital Karachi, Pakistan. All adult patients who underwent CCTA from 1-1-2005 to 1-11-2016 were included in the study. Results: Among 897 patients undergoing CCTA, 36 (4.01%) patients were identified as having coronary artery anomalies (CAA). The mean age of patients was 48.3±11.9 years. Male to female ratio was 3:1. Among patients with CAA, the most common indication for CCTA was screening for coronary artery disease (58.3%). 33 patients (3.67%) showed coronary origin and course anomalies, whereas coronary artery fistulas were identified in 3 patients (0.3%). The most common anomaly identified was the anomalous origin of coronary artery from the opposite coronary sinus with anomalous course (1.4%) with anomalous origin of right coronary artery from the left coronary sinus with an inter-arterial course seen in 9 patients. Single coronary artery was seen in three cases (0.3%), in all these cases the single coronary artery originated from the right coronary cusp. In one patient (0.1%) dual left anterior descending (LAD) system was identified. In two cases (0.2%) fistulous connection of LAD with pulmonary artery was seen, while fistula from LAD to coronary sinus was identified in one patient. Conclusions: This study highlights the fact that the prevalence of coronary anomalies on CCTA in this region is similar to the data reported from the rest of the world. JRCD 2017; 3 (4): 116-121

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Section: Discussionsupporting

confidence: 82%

“…Dual LAD is a benign abnormality with a prevalence of 1% [20] on CCA and 4% [21] on CCTA. In our study one case of dual LAD was identified (prevalence of 0.11%).…”

Section: Discussionmentioning

confidence: 99%

The prevalence of coronary artery anomalies on CT scan; Experience from a tertiary care center in Pakistan (RCD code: I-1C.1)

Hussain

Sultan

Jamil

2017

Journal of Rare Cardiovascular Diseases

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“…In normal anatomy, LAD originates from the LMCA, courses in the AIS towards the cardiac apex, and gives diagonal and septal branches. While septal branches extend to interventricular septum, diagonal branches extend to LV anterior wall (LV diagonals) and sometimes to RV anterior wall (RV diagonals) (1,2).…”

Section: Discussionmentioning

confidence: 99%

“…First study classifying dual LAD anomalies based on coronary catheter angiography was published in 1983 by Spindola-Franco et al (2), which has served as a primary classification system. However, individual reports further described previously unclassified LAD variants (3,4).…”

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confidence: 99%

Prevalence of dual left anterior descending artery variations in CT angiography

Bozlar

Mş²,

Sarı³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSEWe aimed to evaluate the frequency and features of dual left anterior descending artery (LAD) variants using computed tomography (CT) angiography. METHODSA total of 1337 consecutive coronary CT angiography examinations performed between April 2010 and December 2013 were retrospectively evaluated for the presence of dual LAD. CT examinations were performed with either 64-or 320-row multidetector CT scanners. All CT angiography images were evaluated for the presence and morphologic features of dual LAD subtypes. RESULTSFifty-six dual LAD variations (4%) were identified in this study population. Type 1 was the most common type of dual LAD (n=48), while Type 3 (n=3) and Type 4 (n=2) were infrequent and Type 2 was not detected. Additionally, we detected previously unclassified dual LAD variations in three cases. CONCLUSIONDual LAD may be a relatively more common variant than described in the medical literature, which is mostly based on catheter angiography studies. Coronary CT angiography seems markedly efficacious for detecting and documenting the anatomical details of dual LAD subtypes, as well as showing other associated cardiocoronary anomalies. Dual left anterior descending (LAD) coronary artery is a rare congenital anomaly (1), basically defined as the existence of two distinct segments of the vessel occupying the anterior interventricular sulcus (AIS) of the heart.First study classifying dual LAD anomalies based on coronary catheter angiography was published in 1983 by Spindola-Franco et al. (2), which has served as a primary classification system. However, individual reports further described previously unclassified LAD variants (3, 4). Most of the recent publications about dual LAD anomalies involve case reports and there is a paucity of large series using coronary computed tomography (CT) angiography (3-8).At present, quite a large number of coronary CT angiography examinations are being performed and recognition of dual LAD variations by CT angiography requires familiarity. Being aware of dual LAD anomalies could be critical for coronary bypass surgery and interventions. Surely, sound knowledge on dual LAD anomalies is a prerequisite for proper management of patients with coronary artery disease.In this study, we aimed to identify the frequency of dual LAD variations, and define the morphoanatomical features based on Spindola-Franco classification, using CT angiography. Appendageal subtypes of this variation were also documented and discussed. Methods PatientsThe study was approved by our institutional review board. A total of 1337 consecutive coronary CT angiography examinations performed in our department from April 2010 to December 2013 were retrospectively evaluated for dual LAD anomalies. These examinations had been performed for various reasons including, but not limited to, the assessment of coronary and cardiac morphology, electrocardiography (ECG) abnormalities, coronary bypass graft evaluation, coronary stent evaluation, coronary atherosclerosis evaluation and screening fo...

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“…In this coronary artery anomaly, there are 2 LAD arteries, the first of which is short and the other is long. While the short LAD is the continuation of the LMCA and terminates at the proximal end of the anterior interventricular groove, the long LAD branches off the RCA or the RSV and ends at the apex of the left ventricle (23,24). Furthermore, this type of anomaly is benign in general and does not cause hemodynamic corrosion unless the LAD originating from the RCA or the RSV does not run between the aorta and the pulmonary trunk.…”

Section: Discussionmentioning

confidence: 99%

Relationship between significant coronary artery disease and coronary artery anomalies

Birdane¹

2013

Turk J Med Sci

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Kinetics of the hydrolysis of 3-( 2 -chloro-6 -fluorobenzyl)isocoumarin (1), 3-( 4 -fluorophenyl)isocoumarin(3), 3-( 2 -fluorophenyl)isocoumarin (5), 3-( 2 -chlorophenyl)isocoumarin (7), and 3-( 4 -chlorophenyl)isocoumarin (9) were studied spectrophotometrically in the presence of aqueous solution of potassium hydroxide.The rates of hydrolyses for these isocoumarins were compared. The data for isocoumarin (1) were further investigated to probe the reaction mechanism. The dependence of pseudo-first order rate constant k obs on hydroxide ion concentration is fitted by the expression k obs = ko + k1 [OH] + k 2 [OH] 2 , showing the formation of monoanionic and dianionic tetrahedral intermediates during the course of reaction. The magnitude of k o shows significant participation of solvent in the reaction mechanism.

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Dual left anterior descending coronary artery: Angiographic description of important variants and surgical implications

Cited by 198 publications

References 7 publications

The prevalence of coronary artery anomalies on CT scan; Experience from a tertiary care center in Pakistan (RCD code: I-1C.1)

The prevalence of coronary artery anomalies on CT scan; Experience from a tertiary care center in Pakistan (RCD code: I-1C.1)

Prevalence of dual left anterior descending artery variations in CT angiography

Relationship between significant coronary artery disease and coronary artery anomalies

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