Short branch of type IV dual left anterior descending coronary artery running as an aberrant obtuse marginal branch: a previously undescribed arrangement

Dual left anterior interventricular coronary artery with a rare course in a Korean

Dual left anterior interventricular coronary artery (also called left anterior descending artery, hereafter referred as LAD) is a rare congenital coronary artery anomaly. Notably, type IV dual LAD has never been reported in Koreans. During a routine dissection, a new variant of type IV dual LAD was found in a 57-year-old Korean male cadaver, whose cause of death was unknown. One LAD originated from the right coronary artery, coursed through the anterior interventricular sulcus, but did not reach the apex cordis. The other LAD arose from the left coronary artery, never entered the anterior interventricular sulcus through its course, but reached the apex cordis, where it met the posterior interventricular branch of the right coronary artery. This is the first report on a new variant of type IV dual LAD in Koreans, which is of clinical importance during procedures containing the coronary artery.

[Circumflex angioplasty in a patient with type IV dual left anterior descending coronary artery. Proposal for updating the classification of Spindola-Franco]

The normal anatomy of coronary arteries includes a kind of variants with regard to its origin, distribution and route, which makes that 2 patients do not have coronary arteries exactly alike. Left anterior descending artery could have anatomical variations that do not affect the normal supply of blood to the corresponding myocardial territory. In our 25 years of experience, and more than 11,000 coronary angiographies, we have found only one patient with a type IV dual left anterior descending coronary artery. In this article we show the case of a patient with the described coronary anomaly, presenting a severe stenosis of the circumflex artery which was successfully treated percutaneously. Besides, a proposal for updating the classification of Spindola-Franco is made, where the 4 types previously described were kept invariable, and 7 anatomical variants or subtypes were added.

The parallel left anterior descending coronary artery

The left anterior descending artery (LADA) is defined as the vessel that travels in the anterior interventricular sulcus (AIVS) supplying septal branches to the anterior interventricular septum. Duplication of the LADA entails that two vessels are located in the AIVS. This report presents some comments regarding a case of the so called "parallel LADA" which has been erroneously recognized as dual LADA.