Dual left anterior descending coronary artery: surgical revascularization in 4 patients

Abstract

Dual left anterior descending artery (or dual anterior interventricular artery) is a rare coronary anomaly. It is important to know the anatomic variants of this anomaly in patients with coronary artery disease who are undergoing either surgical myocardial revascularization or coronary angioplasty. We report the cases of 4 patients who had anatomic variants of dual left anterior descending coronary artery. These patients had developed coronary artery disease in the long or the short left anterior descending artery, or in both. The long left anterior descending artery was diseased in 1 patient, and the short left anterior descending artery was diseased in another In the 3rd and 4th patients, both the long and the short arteries were atherosclerotic and had developed severe stenosis. All 4 patients underwent successful myocardial revascularization. There was no electrocardiographic evidence of perioperative myocardial infarction. All patients were asymptomatic during the follow-up period, which ranged from 3 months to 1.5 years. Angiographers and surgeons alike must be aware of the variants of dual left anterior descending coronary artery, so that the diseased vessels can be correctly identified even if 1 of the dual arteries is 100% occluded.

Fig. 1 A) Coronary angiogram of the LCA in the right anterior oblique projection, showing the short LAD arising from the left main. Stenosis of the LMCA and the ramus intermedius is evident. B) Diagrammatic representation of Fig. 1A. C) Angiographic view of the RCA in the right anterior oblique projection showing the origin of the distal LAD from the proximal RCA and stenosis of the mid portion of the RCA. D) Diagrammatic representation of Fig. 1C. LAD = left anterior descending coronary artery; LCA = left coronary artery; LCX = left circumflex artery; LMCA = left main coronary artery; PDA = posterior descending coronary artery; PLB = posterolateral branch; RCA = right coronary artery; RI = ramus intermedius

Fig. 2 A) Angiogram of the LCA in the left anterior oblique projection, showing 100% stenosis of the long LAD, severe stenosis of the short LAD, and stenosis of the LCA proximal to the origin of the obtuse marginal branch. The septal artery originates from the LAD proper. B) Diagrammatic representation of Fig. 2A. br = branch; LAD = left anterior descending coronary artery; LCA = left coronary artery; LCX = left circumflex artery; LMCA = left main coronary artery; OM1 = 1st obtuse marginal branch

Fig. 3 A) Angiogram of the LCA in the left anterior oblique projection, showing stenosis of the short and the long LAD. The long LAD gives rise to the diagonal branches, and the short LAD gives rise to the septal branch. There is stenosis in the 1st obtuse marginal branch. B) Diagrammatic representation of Fig. 3A. br = branch; LAD = left anterior descending coronary artery; LCA = left coronary artery; LCX = left circumflex artery; LMCA = left main coronary artery; OM1 = 1st obtuse marginal branch

Fig. 4 Angiogram of the LCA, showing stenosis of the long and the short LAD. The long LAD gives rise to all the septal branches throughout and to 1 diagonal branch in the distal third. The short LAD gives rise to diagonal branches only. LAD = left anterior descending coronary artery; LCA = left coronary artery