Images in Cardiovascular CT
Novel variant of dual left anterior descending coronary artery

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Abstract

A 29-year-old African American man presented with atypical chest pain. Coronary computed tomographic angiography (64-slice) showed a previously not described variant of dual (duplicated) left anterior descending artery (LAD). Duplication of LAD is a rare anomaly and has been categorized into 4 angiographic subtypes based on the origin, course, and termination of the short and long LAD. Our case is unique in that, unlike previous subtypes, the short LAD originates independently from the left coronary sinus and that the long LAD arises from the right coronary sinus and has an intramyocardial course before reaching the distal interventricular groove. It can be, thus, considered a new variant of dual LAD (type V).

Section snippets

Case history

A 29 year-old man presented with atypical chest pain. Physical examination, electrocardiogram, and cardiac enzymes were normal. Coronary computed tomographic angiography (64-slice) showed a novel variant of dual (duplicated) left anterior descending artery (LAD) coronary artery. The short LAD had a separate origin from the left coronary sinus and terminated in the proximal interventricular groove, giving off the first septal perforator. The long LAD originated from the right coronary sinus

Discussion

Duplication of the LAD is a rare anomaly and has been categorized into 4 angiographic subtypes,1, 2 based on the origin, course, and termination of the short and long LAD as shown in Table 1. A recent report has shown the coronary computed tomographic angiography characteristics of dual LAD.3 Our case is unique in that the short LAD originates independently from the left coronary sinus and that the long LAD arises from right coronary sinus and has an intramyocardial course before reaching the

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Cited by (35)

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    2019, Journal of Cardiology Cases
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    Duplication of LAD has been categorized into 4 angiographic subtypes based on the origin, course, and termination of the S- and L-LAD [3]. Based on CCTA imaging, five additional subtypes including a new variant of type X were later published [3,7,8]. In this study, the anomalous LAD origin and the course was consistent with the type X variety of dual LAD as described in the literature, and presented in Table 1 and hence a rare entity [1].

  • A new variation of dual left anterior descending coronary artery

    2016, Journal of Cardiology Cases
    Citation Excerpt :

    To our knowledge, this combination of dual LAD has not been reported in the literature and this new variation may show a rare risk of coronary ischemia due to its intramyocardial course as compared with type V. Utilization of CCTA is advocated for full evaluation of dual LADs [1,4–6]. In types IV–VI, the anatomical determination of the course of anomalous long LAD is considered to be clinically important to rule out a high-risk course by CCTA [4,5].

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

    2015, Indian Heart Journal
    Citation Excerpt :

    However, coronary computed tomographic angiography (CCTA) imaging allows clinicians to notice other variants of dual LAD anomaly in current era.3 Uptil date, 9 types of dual LAD variants detected from not only classical coronary angiogram but also CCTA imaging have been reported.2–6 In the current case, we tried to present a novel case of dual LAD anomaly demonstrated by CCTA during preoperative evaluation which has not been previously reported.

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Conflict of interest: The authors report no conflicts of interest.

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