Surgical revascularization of a rare type IV dual left anterior descending artery—a case report

Abstract

Abstract Background Type IV dual left anterior descending artery (LAD) is a rare congenital coronary anomaly. Though benign with most of the patients being asymptomatic, knowledge of its existence and identification during coronary angiography is important during coronary interventions and surgical revascularization. Case presentation We present a rare case of type IV dual left anterior descending artery (LAD) with anomalous origin of one of the two vessels from the right coronary sinus. A 49-year-old female presented with inferior wall infarction and she underwent coronary angiography. Coronary angiogram showed triple vessel coronary artery disease. This rare variant of dual LAD was identified and was confirmed intra-operatively. The patient underwent coronary revascularization with grafts to both the LAD systems. Conclusions Proper assessment of the angiogram and knowledge of the coronary anomalies is required during surgical revascularization and percutaneous coronary interventions. This rare anomaly can be missed due to the anomalous origin of the LAD from the right coronary sinus. The identification of the dual LAD and grafting of both the LAD systems is required to achieve complete revascularization.