Anomalous left anterior descending artery: prepulmonic course

Case contributed by Dr Yune Kwong


Abnormal catheter angio - for characterization

Patient Data

Age: 67
Gender: Male

Both the right coronary artery (black arrow) and left main stem (white arrow) arise from the right coronary sinus (from separate ostia). The left main stem has a pre-pulmonic course, passing anterior to the right ventricular outflow tract.

The left main stem bifurcates into the left anterior descending artery (blue arrow) and circumflex artery (green arrow)

Case Discussion

An anomalous coronary artery arising from the opposite sinus usually takes four common courses:

  1. interarterial (i.e. between the aorta and the pulmonary artery) - this is the most dangerous as it carries a high risk of sudden cardiac death (malignant course)
  2. retroaortic
  3. prepulmonic
  4. septal (subpulmonic)

In the case above, the course of the LAD is prepulmonic, and this is not a malignant course.

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Case information

rID: 29253
Published: 12th May 2014
Last edited: 14th Aug 2019
System: Cardiac
Inclusion in quiz mode: Excluded

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