A case of dual left anterior descending artery with myocardial infarction

Dheeraj, Abhaykumar Binodkumar; Giri, Sandeep Kumar; Ghormade, Pankaj Suresh

doi:10.4322/acr.2020.223

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Sumário

Autopsy Case Report and Review • Autops. Case Rep. 10 (4) • 2020 • https://doi.org/10.4322/acr.2020.223 copy

A case of dual left anterior descending artery with myocardial infarction

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The Left anterior descending artery (LAD) is a branch of the left main coronary artery which runs obliquely towards the apex of the heart in the anterior interventricular sulcus. Among all of the coronary arteries, the LAD artery has the most constant course. Amongst the anomalies of coronaries, the duplication or bifurcation of the LAD artery is infrequent. The classification of the bifurcation of the LAD has been extensively described in various reports with the widespread use of CT Angiography. We describe herein, an anomalous LAD detected on autopsy. This unusual case highlights the gross autopsy finding of Type-I anomalous dual LAD coronary artery in a young adult who died of Myocardial Infarction.

Keywords
Anomalous Left Coronary artery; Myocardial Infarction; Autopsy

Type of dual LAD	LAD Proper	Short LEFT ANTERIOR DESCENDING ARTERY		Long LAD
Type of dual LAD	LAD Proper	Origin	Termination	Origin	Course and Location
Type-1³3 Spindola-Franco H, Grose R, Solomon N. Dual left anterior descending coronary artery: angiographic description of important variants and surgical implications. Am Heart J. 1983;105(3):445-55. http://dx.doi.org/10.1016/0002-8703(83)90363-0. PMid:6829406. http://dx.doi.org/10.1016/0002-8703(83)9...	Present	From LAD proper	In proximal AIVS	From LAD proper	In proximal AIVG epicardially on LV side, re-enters the distal AIVS
Type-2³3 Spindola-Franco H, Grose R, Solomon N. Dual left anterior descending coronary artery: angiographic description of important variants and surgical implications. Am Heart J. 1983;105(3):445-55. http://dx.doi.org/10.1016/0002-8703(83)90363-0. PMid:6829406. http://dx.doi.org/10.1016/0002-8703(83)9...	Present	From LAD proper	In proximal AIVS	From LAD proper	In proximal AIVG epicardially on RV side, re-enters the distal AIVS
Type-3³3 Spindola-Franco H, Grose R, Solomon N. Dual left anterior descending coronary artery: angiographic description of important variants and surgical implications. Am Heart J. 1983;105(3):445-55. http://dx.doi.org/10.1016/0002-8703(83)90363-0. PMid:6829406. http://dx.doi.org/10.1016/0002-8703(83)9...	Present	From LAD proper	In proximal AIVS	From LAD proper	In proximal AIVG intramyocardially, re-enters epicardially in the distal AIVS
Type-4³3 Spindola-Franco H, Grose R, Solomon N. Dual left anterior descending coronary artery: angiographic description of important variants and surgical implications. Am Heart J. 1983;105(3):445-55. http://dx.doi.org/10.1016/0002-8703(83)90363-0. PMid:6829406. http://dx.doi.org/10.1016/0002-8703(83)9...	Absent	From LMCA	In proximal AIVS	From RCA	In proximal AIVS epicardially along anterior to RVOT, re-enters epicardially in the distal AIVS
Type-5⁵5 Manchanda A, Qureshi A, Brofferio A, Go D, Shirani J. Novel variant of dual left anterior descending coronary artery. J Cardiovasc Comput Tomogr. 2010;4(2):139-41. http://dx.doi.org/10.1016/j.jcct.2009.12.007. PMid:20430346. http://dx.doi.org/10.1016/j.jcct.2009.12...	Absent	From LCS	In proximal AIVS	From RCS	Intramyocardially within septal crest, re-enters epicardially in the distal AIVS
Type-6⁶6 Maroney J, Klein LW. Report of a new anomaly of the left anterior descending artery: type VI dual LAD. Catheter Cardiovasc Interv. 2012;80(4):626-9. http://dx.doi.org/10.1002/ccd.23219. PMid:21953811. http://dx.doi.org/10.1002/ccd.23219...	Absent	From LMCA	In proximal AIVS	From RCA	Epicardially between RVOT and aortic root, continuing to distal AIVS
Type-7⁷7 Saglam M, Ozturk E, Kara K, Kardesoglu E, Mutlu H. A new variation in coronary artery anatomy: type VII dual left anterior descending artery. Kardiol Pol. 2015;73(3):217. http://dx.doi.org/10.5603/KP.2015.0042. PMid:25791971. http://dx.doi.org/10.5603/KP.2015.0042...	Absent	From LMCA	In proximal AIVS	From RCS	Intramyocardially in septal crest, emerging epicardially in distal AIVS
Type-8²2 Bozlar U, Uğurel MS, Sari S, Akgün V, Örs F, Taşar M. Prevalence of dual left anterior descending artery variations in CT angiography. Diagn Interv Radiol. 2015;21(1):34-41. http://dx.doi.org/10.5152/dir.2014.14275. PMid:25333217. http://dx.doi.org/10.5152/dir.2014.14275...	Absent	From LMCA	In proximal AIVS	From mid RCA	Epicardially in inferior surface of RV, re-enters epicardially in the distal AIVS
Type-9²2 Bozlar U, Uğurel MS, Sari S, Akgün V, Örs F, Taşar M. Prevalence of dual left anterior descending artery variations in CT angiography. Diagn Interv Radiol. 2015;21(1):34-41. http://dx.doi.org/10.5152/dir.2014.14275. PMid:25333217. http://dx.doi.org/10.5152/dir.2014.14275...	Present	From LAD proper	In mid AIVS	From LAD proper	Epicardially on LV side, re-enters epicardially in the distal &terminates before reaching the apex.

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[1] Authors’ contributions: All authors contributed equally to this work from performing the autopsy to writing the manuscript. All authors proofread and approved the final paper’s version to be published.