Is the left anterior descending artery really absent?--a decisive input from coronary CT angiography

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Invasive coronary angiography via catheterization (Cath) is standard for diagnosing coronary artery anomalies.
• Difficult cannulation can hinder accurate diagnosis during cardiac catheterization.

Observation:

• A patient with suspected coronary anomalies presented with multiple failed catheterization attempts to identify the left anterior descending artery (LAD).
• The initial catheterization led to a suspected diagnosis of absent LAD.

Findings:

• Coronary CT angiography (CTA) was employed as a secondary imaging modality.
• CTA successfully visualized the LAD originating from a separate ostium in the left sinus of Valsalva.
• The final diagnosis was absent left main artery with dual left coronary ostia.

Implications:

• Coronary CT angiography serves as a vital backup imaging tool for complex coronary anomalies.
• CTA enhances diagnostic accuracy in cases of difficult cannulation during invasive procedures.
• This case highlights the utility of CTA in resolving diagnostic uncertainties in congenital coronary artery variations.