Dual left anterior descending coronary artery type IV

Case contributed by Dr Abdulmajid Bawazeer

Presentation

Chest pain on exertion, no shortness of breath.

Patient Data

Age: 45 years
Gender: Male

Accessory opacified artery branching anteriorly and early from the right coronary artery.
The LAD appears relatively smaller in the caliper and course shortly.
Otherwise, normal DSA coronary arteries.

Dual left anterior descending one from the left coronary artery and the other from right coronary artery coursing in the anterior interventricular sulcus. 
Otherwise normal coronary angiography.

Accessory opacified artery branching anteriorly and early from the right coronary artery.
​The LAD appears relatively smaller in the caliper and course shortly.
Otherwise, normal DSA coronary arteries.

LAD = Left anterior descending artery.
LCx = Left circumference artery.
RCA = Right coronary artery.

Dual left anterior descending one from the left coronary artery and the other from right coronary artery coursing in the anterior interventricular sulcus. 
Otherwise normal coronary angiography.

LAD = Left anterior descending artery.
LCx = Left circumference artery.
RCA = Right coronary artery.
 

Case Discussion

The double LAD coronary artery originating from the left main coronary stem and the right coronary artery is a rare congenital coronary anomaly1. It reported occurring in 0.64–1.3% of patients undergoing coronary angiography. 
Dual LAD had been reported to occur with an incidence of 1% by Spindola-Franco et al 3

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