Dual Left Anterior Descending Research Articles

The Role of Coronary CT Angiography in the Evaluation of Dual Left Anterior Descending Artery Prevalence and Subtypes: A Retrospective Multicenter Study.

The aim of this multicenter study was to evaluate the prevalence and features of dual left anterior descending artery (LAD) subtypes using coronary CT angiography (CCTA). A retrospective multicenter analysis of 2083 CCTA from December 2020 to November 2022 was conducted to search for the presence and morphological features of dual LAD. The two classifications used were the updated classification of Spindola-Franco and the Jariwala classification. Statistical tests were conducted to evaluate the prevalence of dual LADs among sexes and its association with angina in patients without significant coronary stenoses and/or associated cardiac anomalies. Dual LAD was observed in 124 (5.96%) patients analyzed. According to the Spindola-Franco revisited classification, type I dual LAD was the most common (71/124, 57.26%). According to the Jariwala classification, all cases were group I. In the general population, there was a higher prevalence of dual LAD among females (7.3% females vs. 5.1% males; p value: 0.04). No statistically significant difference was found in the prevalence of angina in the dual LAD population compared to the no dual LAD population (2.1% vs. 1.5%; p value: 0.10). The acknowledgment and reporting of LAD duplication is helpful for an optimal management of coronary patients with this condition. Dual LAD was more frequent in the female population, mainly not related with angina. Myocardial bridge was more frequent in the dual LAD population than in the no dual LAD population.

Tetralogy of Fallot with Dual Left Anterior Descending Artery: A Rare Transesophageal Echocardiographic Illustration

Tetralogy of Fallot with Dual Left Anterior Descending Artery: A Rare Transesophageal Echocardiographic Illustration

Dual Left Anterior Descending, Interarterial Principal LAD, and Anomalous Circumflex, Presenting With Acute Coronary Syndrome

Coronary artery anomalies are rare, but even rarer are the constellations of coronary anomalies. This article describes a very rare constellation of anomalous coronary arteries identified in the context of a non−ST-elevation myocardial infarction (NSTEMI). In addition to describing this challenging case, this article provides tips and tricks for operators on catheter selection to optimize the engagement of these atypical coronary arteries and highlights the high-risk features of coronary anomalies based on the arterial course, ostium shape, and vessel size.

A rare case of dual left anterior descending arteries arising from left main coronary artery and right sinus of Valsalva

Duplication of left anterior descending (LAD) artery is an uncommon coronary anomaly. Type IV dual LAD is the rarest variety where short LAD arises from left main stem and long LAD arises from right coronary artery or right sinus of Valsalva. I present a case of 60-years-old lady with dilated cardiomyopathy with incidental detection of type IV dual LAD during coronary angiography. The patient was treated conservatively

Type X dual left anterior descending (LAD) artery masquerading as type 1 LAD \u2014 a case report

BackgroundDual left anterior descending (LAD) coronary artery is a rare congenital anomaly. To date, eleven variants of dual LAD have been described with three published reports of type X dual LAD. Here, we describe a new variant of type X dual LAD with a short LAD artery masquerading as type 1 LAD.Case presentationA 42-year hypertensive female presented with recent onset angina with a treadmill test positive for inducible ischemia. Coronary angiography showed a normal right coronary artery (RCA). The left main coronary artery (LMCA) originated from the left sinus of Valsalva (SOV), giving rise to a LAD and the left circumflex artery (LCX). Appearing a normal angiogram with type 1 LAD based on its length, the presence of a large bare area in LAD territory (especially at the apex) and lack of septal branches prompted a search for an additional vessel. Right SOV injection showed a vessel originating separately from RCA, which was confirmed to be a long LAD on selective injection, with a pre-pulmonic course and giving rise to septal branches exclusively before wrapping around the apex. Computed tomography coronary angiography (CTCA) confirmed the pre-pulmonic course of long LAD, defined its entry to the distal interventricular septum to the right of short LAD, and ruled out other coronary artery anomalies. In the absence of a stenotic lesion in the epicardial coronaries, angina in our case was presumed to be due to microvascular dysfunction. She was discharged on beta-blocker therapy for co-existing hypertension and is asymptomatic on follow-up at one year.ConclusionsA short LAD artery of type X Dual LAD could be potentially misdiagnosed as type 1 LAD based on its length. However, an active search for a long LAD could properly diagnose the case as a variant of type X dual LAD, which has important clinical implications. Its awareness is critical for cardiologists and cardiac surgeons to correctly interpret the coronary angiogram and plan proper management.

Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital of Northern India.

Objectives: To evaluate the prevalence and pattern of congenital coronary artery anomalies (CAAs) in the adult population undergoing catheter coronary angiography.Methods: The coronary angiograms done between October 2015 and September 2020 were reviewed for the presence of coronary anomalies based upon Angelini's classification. The medical record of patients with anomalies was reviewed for symptomatology and indication of angiography.Results: CAAs were found in 129 (87 males and 42 females) of 6,258 patients giving a prevalence of 2.06%. The mean age was 57.8 ± 11.8 (range 32-81) years. Among these, the anomalous origin and course of the coronaries were the most common anomaly seen in 81 (1.29%) patients, followed by intrinsic anomalies of the coronary arterial system in 44 (0.7%) patients and anomalies of coronary termination and anomalous anastomotic vessels in 2 (0.03%) patients each. Overall, the absence of the left main trunk with a separate origin of the left anterior descending (LAD) and the circumflex artery was the commonest anomaly seen in 46 (0.74%) patients, followed by dual LAD in 35 (0.56%) patients. The anomalous origin of the right coronary artery (RCA) from the left sinus was seen in 14 patients (0.22%) and that of the circumflex artery from the right sinus or right coronary artery was seen in 11 patients (0.17%). The origin of the left main and RCA from ascending aorta was found in eight (0.13%) patients. One (0.02%) patient had a single coronary artery, and another one (0.02%) had all the three coronary arteries arising from the right sinus; however, with separate ostia. The split RCA was seen in nine (0.14%) patients and there were two (0.03%) patients each of coronary artery fistulae, and of anomalous anastomotic vessels.Conclusions: The prevalence of congenital coronary anomalies in this study was 2.06%. The commonest anomaly was that of origin and courses of the vessels, however, the pattern of anomalies is different from previous studies.

Dual Left Anterior Descending Artery with abberrent left circumflex artery: dual abberrency- a multi-modality imaging based identification.

Dual left anterior descending (LAD) artery with separate origin of the long LAD with left main coronary artery (LMCA) continuing as short LAD is very rare. A 67-year-old diabetic, and hypertensive male was admitted with history of exertional dyspnoea. He underwent coronary angiography, which showed LMCA continuing as short LAD with early termination while single trunk from right coronary sinus was giving rise to long LAD, right coronary artery, and left circumflex artery (LCx). The long LAD, running on the right side of the anterior interventricular groove, entered the groove distally while anomalous LCx which was dominant, was following a retro-aortic course. These were subsequently confirmed on Multidetector computed tomography angiography (MDCT). Therefore, dual LAD with long LAD, dominant anomalous circumflex artery, and right coronary artery sharing a single, and common origin is very rare and to the best of our knowledge, is being reported for the first time.

Type IV dual left anterior descending coronary artery: a case report

BackgroundDual 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 presentationWe 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.ConclusionWe 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.

Dual Left Anterior Descending Artery with Anomalous Origin of Left Anterior Descending Artery from Pulmonary Artery: A Rare Anomaly

Dual Left Anterior Descending Artery with Anomalous Origin of Left Anterior Descending Artery from Pulmonary Artery: A Rare Anomaly

Reverse type IV dual left anterior descending coronary artery accompanying with anomalous origin of circumflex artery from right coronary sinus

Abstract 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.

Coronary artery anomaly: Rare and anomalous branching of left coronary artery

Coronary artery anomalies are rare, but still rarer is anomalous branching pattern of the left coronary artery (LCA) alone, without any congenital anomalies. We report the case of a 50-year-old man who presented with dyspnea on exertion New York Heart Association (NYHA) class II, had a positive stress test, and his coronaryangiogram revealed the left main coronary artery (LMCA) dividing into four branches. This type of branching pattern is quite rare. He had type I dual left anterior descending (LAD) artery in addition to a fairly large ramus intermedius (RI) and a nondominant left circumflex (LCx) arising from the LCA. Awareness and recognition of dual LAD is of importance to surgeons and interventionalists alike in planning the revascularization strategy.

A Combination of Two Rare Coronary Anomalies Makes It Even Rarer: Right Sided Single Coronary Artery with Dual Left Anterior Descending Artery

An 82-year-old female with history of hyperlipidemia and hypertension presented to the clinic with chief complaint of nonradiating chest tightness accompanied by exertional dyspnea. Cardiac catheterization showed the absence of left coronary system; the entire coronary system originated from the right aortic sinus as a common trunk which then gave off the right coronary artery and the left main coronary artery. Cardiac catheterization demonstrated also another rare coronary anomaly: dual left anterior descending artery. Patient underwent percutaneous coronary intervention and subsequent multidetector computed tomography angiography confirmed the above angiography findings. Patient was subsequently discharged home on double antiplatelet therapy with aspirin and clopidogrel and has been asymptomatic since then.

A new anomaly of the left anterior descending artery: Type X dual LAD

Dual left anterior descending (LAD) coronary artery anomaly is traditionally classified as four types anomaly by classical coronary angiogram. Nowadays, coronary computed tomographic angiography (CCTA) allows clinicians to understand other variants of dual LAD anomaly. Up to date, 9 types of dual LAD variants detected from not only classical coronary angiogram but also CCTA imaging have been reported.In the present case, we aimed to show a novel dual LAD anomaly, which is demonstrated by CCTA during preoperative evaluation and it has not been previously reported.

Dual LAD – Contemporary Review

Dual LAD had been reported to occur with an incidence of 1% by Morettin [1] as well as Spindola-Franco et al. [2]. There is a lot of case reports on dual left anterior descending (LAD) coronary artery. The first description of a type IV dual LAD distribution was made in 1939, by Waterston et al. [3] in the case of Sir James Mackenzie, who had this type of distribution. By now six types of this anomaly have been described in the literature. But there is no any review article describing this anomaly in general, so we decided to write one.

Dual Left Anterior Descending Artery Arising From Left Circumflex Artery With an Intramyocardial Coronary Aneurysm

Dual left anterior descending (LAD) artery is a rare anomaly conventionally classified into 4 types. We present a case of dual LAD artery in which the long LAD artery has arisen from the left circumflex (LCx) artery, a condition not previously included in the 4 defined types. Moreover, the long LAD artery specified here is associated with an intramyocardial coronary aneurysm. To our best knowledge, it is the first time such a coronary artery anomaly has been reported. This case suggests the important role of coronary computed tomography angiography (CTTA) for diagnosis and therapeutic planning for such an anomaly.

An Unusual Case of Dual Left Anterior Descending Artery with Coronary Computed Tomographic Angiographic Correlation

Dual left anterior descending artery (LAD) is a rare coronary anomaly that is important to recognize at coronary imaging as it may influence reperfusion strategies. Four types of dual LAD are described by the traditional literature. We present a novel case of dual LAD with coronary computed tomographic angiographic correlation that does not fit into this classification system. Rather, our case supports the recently proposed notion of adding a fifth variant to the traditional dual LAD classification system.

Report of a new anomaly of the left anterior descending artery: Type VI dual LAD

A 48-year-old man with past medical history of coronary artery disease, previous angioplasty, hyperlipidemia, and generalized anxiety disorder presented with atypical chest pain. Coronary angiography and CT angiography revealed a variant dual left anterior descending (LAD) coronary artery not previously described. Spindola-Franco et al. have categorized dual LAD into four angiographic subtypes based on the origin and course of both a short- and a long branch of the LAD. Additionally, Manchanda et al. have described a novel variant of dual LAD with the short- and long LAD originating directly from the left and right coronary sinuses, respectively (Type V, see Table I). In the case presented, the long LAD arises from the right coronary artery and follows a unique route underneath the right ventricular outflow tract in the interventricular septal area to the anterior interventricular groove. We propose that this anatomy represents a new variant of dual LAD (Type VI).

Dual Left Anterior Descending Artery With Dominant Long Left Anterior Descending Artery Ascending as Posterior Interventricular Artery

A dual left anterior descending coronary artery (LAD) system is a rare anatomic variant of the coronary circulation. In the most common form (type I), the dual LAD can be recognized by an early bifurcation of the LAD proper into a “short” LAD (Fig 1; yellow star) giving rise to all septal perforators and a “long” LAD (Fig 1; green star) giving rise to all diagonal branches (Fig 1; LV = left ventricle). A “dominant” LAD, described as an apical wraparound LAD artery, continuing as the only posterior interventricular (PIV) arterial branch, is also exceedingly uncommon.

A coronary artery anomaly : type IV dual left anterior descending artery

Coronary artery anomalies are seen in about 1.3% of patients undergoing coronary angiography. However, the dual type of left anterior descending (LAD) artery is a rare form of coronary artery anomaly. There are four types of dual LAD; type IV describes the anomaly of a rudimentary LAD artery terminating in the mid-portion of the anterior interventricular sulcus, and the presence of another LAD originating from the right coronary artery and continuing to the anterior interventricular sulcus.

Coronary Diameter and Vasodilator Function in Children Following Arterial Switch Operation for Complete Transposition of the Great Arteries

Coronary reimplantation during arterial switch operation (ASO) may affect coronary artery growth and function during childhood. The purpose of this study was to assess coronary artery diameter and regional myocardial blood flow (MBF) and myocardial flow reserve (MFR) in children after neonatal ASO. We measured proximal diameters of left anterior descending (LAD), left circumflex, and posterior descending coronary arteries on coronary angiogram in 12 children (median age 11 years, range 7.6 to 15.1) with a history of neonatal ASO. These children then underwent cardiac positron emission tomographic imaging using nitrogen-13 ammonia to assess MBF at baseline and during intravenous adenosine hyperemia in regions supplied by these 3 coronary arteries. Coronary artery z-scores were within normal range (-2.0 to 2.0) for 32 of 36 coronary arteries. MFR (ratio of hyperemic to basal MBF) was normal (>2.5) in all myocardial regions in 10 of 12 patients. The remaining 2 patients, 1 with a dual LAD and 1 with LAD origin from the right coronary artery, had generalized impairment of hyperemic MBF (<2.0 ml/g/min) and low MFR (<2.5). Coronary artery z-scores and MFR in corresponding myocardial territories were not correlated (r = 0.15, p = 0.36). In conclusion, coronary growth and function appear to be normal in most children after neonatal ASO. Children with anatomic LAD abnormalities may be at increased risk of impaired MFR.