Dual left anterior descending artery: Case series based on novel classification and its therapeutic implications

Jariwala, Pankaj; Jadhav, Kartik

doi:10.1016/j.ihj.2022.04.002

Cited by 9 publications

(8 citation statements)

References 45 publications

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“…Duplication of the LAD coronary artery is an unusual variant, and several subtypes have been described. Type IV dual LAD is the rarest form of the duplication of LAD coronary artery in which short LAD arises from the left coronary artery, whereas long LAD originates from the right sinus of Valsalva or right coronary artery, as in the present case [2]. This rare anomaly can present with nonspecific and unusual symptoms, and it can easily be misdiagnosed as proximal LAD occlusion in coronary angiography.…”

mentioning

confidence: 77%

A young patient with Gerbode defect and type IV dual left anterior descending coronary artery

Ufuk¹,

Alver²,

Yaylali

2022

Coronary Artery Disease

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mentioning

confidence: 77%

A young patient with Gerbode defect and type IV dual left anterior descending coronary artery

Ufuk¹,

Alver²,

Yaylali

2022

Coronary Artery Disease

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“…What has also created further ambiguity is the fact that numerous dual LAD cases have been unclassified. 11 After excluding the least prominent characteristics serving as the foundation for earlier classifications, Jariwala et al 12 offered a new classification of the LAD based on angiographic and autopsy findings to eliminate the ambiguity caused by a rising number of dual LAD cases ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“… 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. Because the main septal perforators often originate from the short LAD and the major diagonal arteries typically originate from the long LAD, this mistake might result in unusual and seemingly disparate observations of coronary artery lesions and regional wall motion abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Dual Left Anterior Descending Artery: Clinical Overview and Interventional Management

Masoumi,

Separham,

Parizad

et al. 2023

JTHC

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Congenital coronary artery anomalies are relatively rare, occurring in approximately 0.6%-1.3% of cases undergoing coronary angiography. Among these anomalies, a unique cardiac abnormality known as a dual left anterior descending artery (LAD) stands out. A dual LAD is characterized by the presence of 2 LADs in the anterior interventricular sulcus. This structural deviation consists of a shorter LAD that terminates high in the anterior interventricular sulcus and a longer LAD that extends to the distal sulcus, supplying blood to the cardiac apex. Percutaneous procedures on dual LADs are even less frequent. We describe a 53-year-old woman with typical burning chest pain, ST-elevation in leads I and aVL, and positive troponin I enzyme. Coronary angiography revealed a thrombotic lesion with 99% stenosis at the proximal part of the LAD. The main LAD originated properly from the left coronary cusp, and the remainder of its course was supplied by a second branch originating from the right coronary cusp. Computed tomography angiography and echocardiography were performed for the LAD course. The patient was discharged after an uneventful 1-week hospital stay. Our case is particularly noteworthy for several reasons. Firstly, this dual LAD anomaly is uncommon, and patients with dual LADs less frequently have a ramus artery. Secondly, there have been only a few documented cases of percutaneous transluminal coronary angioplasty performed on short LADs. The key takeaway from this scintillating case study is the significance of identifying the artery responsible for blood supply to the cardiac apex.

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“…Duplication of the LAD artery on CCTA has been reported to occur in 0.68 to 6% of the general population in different case series [10]. The prevalence of dual LAD described in the CCA literature was 1%, which is lower than the prevalence described for CCTA [11][12][13]. CCA may suffice to establish a diagnosis when both short and long LAD arises from common LAD (LAD proper), because when the long LAD originates from the opposite coronary sinus or when the vessel is totally occluded there is a risk of misrecognition.…”

Section: Of 12mentioning

confidence: 95%

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

Maggialetti,

Greco,

Lorusso

et al. 2023

JPM

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Background: 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). Methods: 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. Results: 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). Conclusions: 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.

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Dual left anterior descending artery: Case series based on novel classification and its therapeutic implications

Cited by 9 publications

References 45 publications

A young patient with Gerbode defect and type IV dual left anterior descending coronary artery

A young patient with Gerbode defect and type IV dual left anterior descending coronary artery

Dual Left Anterior Descending Artery: Clinical Overview and Interventional Management

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

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