Surgical revascularization of a rare type IV dual left anterior descending artery—a case report

Abstract

Background Type IV dual left anterior descending artery (LAD) is a rare congenital coronary anomaly. Though benign with most of the patients being asymptomatic, knowledge of its existence and identification during coronary angiography is important during coronary interventions and surgical revascularization. Case presentation We present a rare case of type IV dual left anterior descending artery (LAD) with anomalous origin of one of the two vessels from the right coronary sinus. A 49-year-old female presented with inferior wall infarction and she underwent coronary angiography. Coronary angiogram showed triple vessel coronary artery disease. This rare variant of dual LAD was identified and was confirmed intra-operatively. The patient underwent coronary revascularization with grafts to both the LAD systems. Conclusions Proper assessment of the angiogram and knowledge of the coronary anomalies is required during surgical revascularization and percutaneous coronary interventions. This rare anomaly can be missed due to the anomalous origin of the LAD from the right coronary sinus. The identification of the dual LAD and grafting of both the LAD systems is required to achieve complete revascularization.

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

“…The presence on an intramyocardial LAD complicates the surgical process in CABG surgery, firstly identifying the exact location of the LAD at times can be time consuming and frustrating, increasing both the ischemic time and bypass times and the dissection process may be associated with damage to the LAD, diagonals the great cardiac vein and inadvertent entry into the right ventricle. 5 Localization of the intramyocardial part also identifies the coronary artery where atheromatous process is less likely to affect the coronary artery. 6 Performing a distal arteriotomy over the epicardial portion of a coronary and passing a fine malleable probe gently proximally has been adopted for more than half a century as a reliable method of identifying the proximal intramyocardial LAD.…”