Dual connection of the left anterior descending coronary artery to the left and right coronary arteries

Dual Left Anterior Descending Artery: Case series based on novel classification and its therapeutic implications

Angiographically, a “dual LAD” is described as two distinct arteries supplying the vascular territory of the LAD in parts, identified as the short LAD/LAD₁ and the long LAD/LAD₂. Using an easy-to-understand three-step approach, Jariwala et al unveiled a novel classification strategy for dual LAD systems in an attempt to decrease ambiguity in diagnosis and management of the anomaly. As part of our research, we looked at a wide range of published cases and case series in the literature, and also those reported from our hospital. In our novel classification system, we divide dual LADs into three main groups based on their origin and vascular territory, each of which is further divided into subgroups based on the course of LAD₁/LAD₂ and the variable feature that is a distinguishing attribute of the type of anomaly to be specified.

A review of 144 publications in the world literature revealed 340 patients eligible for the study. The median age was 58.8 years (SD - 11.42; range - 29–89) with male predominance (3.3:1). Cases in Group I comprised 60.6% of the total cases, followed by Group II (36.2%), and Group III (3.2%). Subgroup I-A was the most common in terms of dual LAD, followed by subgroup II-A. Acute coronary syndrome (45.5%) and chronic coronary syndrome (55.8%) were the most common clinical presentations in patients with significant coronary artery disease (30.8%).

Dual left anterior descending artery: diagnostic criteria and novel classification

Duplication of the left anterior descending artery is an uncommon coronary anomaly. Since no proper classification has been established after the initial description and numerical classification by Spindola-Franco et al., many newer numbers have evolved with many overlapping and unclassified variants described in the literature. Identification and reasonable management strategies for dual left anterior descending artery (LAD) are crucial in preventing the long-term disastrous consequences of inadequate revascularization. Clinicians and diagnosticians should be aware of this specific angiographic-based congenital coronary abnormality of the LAD. We, therefore, sought a new, reasonable classification of the dual LAD system, which would clarify this ambiguity, which also has therapeutic implications.

The cristal (right superior septal) coronary artery and its relationship to anomalous left coronary origin

The cristal artery is an occasional finding, being visible in around 3% of coronary angiograms, arising from the proximal right coronary artery (RCA) and passing downwards and forwards through the muscle of the crista superventricularis. It supplies a variable volume of the superior interventricular septum, and can contribute to collateralization of the other septal vessels. When part or all of the left coronary artery (LCA) arises anomalously from the right coronary sinus, its passage to the left may be in the same pathway as a cristal artery, bearing a tell-tale septal vessel arising from its proximal segment. This helps to differentiate it from one that has a higher pathway, running between the great vessels, and which may have a greater correlation with sudden cardiac death.

Imaging of coronary artery anomalies

Coronary artery anomalies (CAA) are uncommon congenital variations in coronary anatomy, occurring in 0.2% to 1.2% of the general population, the majority of which are detected incidentally and have little clinical significance. A minority of CAA, primarily due to an interarterial course, is clinically significant, and may present with symptoms of myocardial ischemia, malignant ventricular arrhythmias, and even sudden cardiac death. Until recently, CAA were primarily detected at catheter coronary angiography. With recent advances in multidetector computed tomography (CT) technology and the use of electrocardiographic gating, coronary CT angiography provides an exquisite omnidimensional display of the anomalous coronary arteries and their relation to the adjacent structures noninvasively, and is the diagnostic test of choice. Understanding CAA morphology and clinical significance of CAA is important for establishing a diagnosis, and is essential for appropriate patient management and treatment planning.

Dual anterior interventricular arteries

A patient with dual left anterior descending (R. interventricularis anterior of the left coronary artery) coronary artery is presented. A normally arising left anterior descending was hypoplastic, and an anomalous left anterior descending, which arose from the right sinus aorticus had a normal caliber. The anomalous left anterior descending artery traversed between the aorta and the pulmonary artery supplying most of the anterior myocardial wall of the left ventricle. This rare coronary anomaly can potentially have implications on percutaneous coronary interventions or on surgical revascularization procedures.

Significance of dual left anterior descending coronary artery in interventional cardiology. A case report

The variants of the left anterior descending (LAD) coronary artery are important in interpretation of coronary angiograms and in interventional procedures. The authors present a patient who had percutaneous transluminal coronary angioplasty and stent implantation to a presumed proximal LAD without the realization that dual LAd was present because of the total occlusion of the long LAD.

Variations in blood supply to the anterior interventricular septum: incidence and possible clinical importance

The variations of the blood supply to the anterior interventricular septum in a series of 1,089 patients are described. Special attention has been given to variations and frequency of occurrence of the septal perforators originating from the left anterior descending artery. These variations may have clinical significance in this era of coronary angioplasty and coronary bypass surgery.

Mid left anterior descending coronary artery originating from the right coronary artery

Dual connection of the left anterior descending coronary artery to the left and right coronary arteries is a very rare congenital anomaly. In this report we describe two cases in which the mid-position of the left anterior descending coronary artery is connected to the right coronary artery, one directly and the second by way of the infundibular artery. To the best of our knowledge, connection of the mid-position of the left anterior descending to the infundibular artery has not been previously described.