A Rare Case of a Type IV Dual Left Anterior Descending Artery and Ectopic Left Anterior Descending and Circumflex
Muhammad Mansoor1, Waqar Ahmad Khan1, Fakhar Abbas2
1National Institute of Cardiovascular Disorders, Karachi, Pakistan.
Insights
Congenital anomalous coronary arteries (CACAs) are usually benign but can cause severe cardiac events. This case highlights a rare CACA presentation in a 62-year-old man, successfully treated with bypass surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Genetics
Background:
- Congenital anomalous coronary arteries (CACAs) represent anatomical variations in coronary vasculature.
- While often benign, certain CACAs can lead to severe ischemic events, including myocardial infarction and sudden cardiac death.
Observation:
- A 62-year-old male presented with acute substernal chest pain, ECG changes (Q waves in leads II, III, aVF), and elevated troponin I.
- Left heart catheterization revealed triple vessel disease with significant left main coronary artery (LMCA) stenosis.
- Anatomical findings included anomalous origin of the left anterior descending (LAD) and left circumflex arteries from the right coronary ostium, and a rudimentary type IV dual LAD from the LMCA.
Findings:
- The patient had complex congenital coronary anomalies combined with significant atherosclerotic disease.
- Surgical intervention involved coronary artery bypass graft (CABG) surgery.
Implications:
- This case underscores the importance of recognizing and managing complex CACAs, especially when associated with atherosclerotic disease.
- Successful surgical revascularization can effectively treat symptomatic patients with these rare anomalies.
- Further research into the long-term outcomes of managing combined CACAs and coronary artery disease is warranted.
Abstract:
Congenital anomalous coronary arteries (CACAs) comprise an important variant of the coronary vasculature. They are benign in the vast majority of cases, whereas a small minority may be affected by serious consequences such as myocardial infarction, arrhythmia, cardiac arrest, and even death. We herein describe a 62-year-old man with sudden and severe substernal chest pain; Q waves in electrocardiographic leads II, III, and aVF; and positive serum troponin I enzyme. Left heart cardiac catheterization revealed triple coronary vessel disease with a 60% to 70% occlusion in the left main coronary artery (LMCA). The left anterior descending (LAD) and the left circumflex artery arose from the ostium of the right coronary artery. Additionally, a rudimentary type IV dual LAD originated from the LMCA. A coronary artery bypass graft surgery was performed using a left internal mammary artery graft for the LAD and a saphenous vein graft for the diagonal branches (I & II) of the LAD and the posterior descending artery. The patient was discharged after an uneventful 1-week hospital course.
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:26Aneurysm III: Interprofessional Care
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:21Cardiac Catheterization II: Right Heart Catheterization