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Dual Left Anterior Descending Coronary Artery: CT Findings

¹ Both authors: Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Health Service, 1500 E Medical Center Dr., Ann Arbor, MI 48109.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Schematics show four subtypes of dual left anterior descending coronary artery (LAD) as described by Spindola-Franco et al. [2]. Types 1–3 (A–C) entail early bifurcation of LAD proper (black arrow) into short LAD (short white arrow), which terminates high in anterior interventricular groove, and long LAD (long white arrow). Notched arrows indicate septal perforators; curved arrows, diagonal vessels; chevron, right coronary artery. Type 1. Proximal long LAD courses parallel to anterior interventricular groove on left ventricle and is source of major diagonal vessels. Short LAD provides major septal perforating vessels.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Schematics show four subtypes of dual left anterior descending coronary artery (LAD) as described by Spindola-Franco et al. [2]. Types 1–3 (A–C) entail early bifurcation of LAD proper (black arrow) into short LAD (short white arrow), which terminates high in anterior interventricular groove, and long LAD (long white arrow). Notched arrows indicate septal perforators; curved arrows, diagonal vessels; chevron, right coronary artery. Type 2. Proximal long LAD courses parallel to anterior interventricular groove on right ventricle. Short LAD provides major septal perforators, and LAD proper provides major diagonal vessel to left ventricle.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Schematics show four subtypes of dual left anterior descending coronary artery (LAD) as described by Spindola-Franco et al. [2]. Types 1–3 (A–C) entail early bifurcation of LAD proper (black arrow) into short LAD (short white arrow), which terminates high in anterior interventricular groove, and long LAD (long white arrow). Notched arrows indicate septal perforators; curved arrows, diagonal vessels; chevron, right coronary artery. Type 3. Long LAD has intramyocardial course.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Schematics show four subtypes of dual left anterior descending coronary artery (LAD) as described by Spindola-Franco et al. [2]. Types 1–3 (A–C) entail early bifurcation of LAD proper (black arrow) into short LAD (short white arrow), which terminates high in anterior interventricular groove, and long LAD (long white arrow). Notched arrows indicate septal perforators; curved arrows, diagonal vessels; chevron, right coronary artery. Type 4. Long LAD has anomalous origin from right coronary artery before entering anterior interventricular groove.

View larger version (91K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —34-year-old woman with atypical chest pain and type 1 dual left anterior descending coronary artery (LAD). Volume-rendered images show short LAD (short straight white arrow) terminating in midportion of anterior interventricular groove. Long LAD (long straight white arrow) originates from LAD proper (black arrow, A), courses parallel to short LAD, gives rise to diagonal vessels (curved arrows), and reenters distal anterior interventricular groove.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —34-year-old woman with atypical chest pain and type 1 dual left anterior descending coronary artery (LAD). Volume-rendered images show short LAD (short straight white arrow) terminating in midportion of anterior interventricular groove. Long LAD (long straight white arrow) originates from LAD proper (black arrow, A), courses parallel to short LAD, gives rise to diagonal vessels (curved arrows), and reenters distal anterior interventricular groove.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —34-year-old woman with atypical chest pain and type 1 dual left anterior descending coronary artery (LAD). Curved planar reformatted view shows origin of major septal perforators (curved arrows) from LAD proper (black arrow) and short LAD (straight white arrow).

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —54-year-old man with type 4 dual left anterior descending coronary artery (LAD) and anomalous left circumflex coronary artery (LCX). Axial maximum-intensity-projection image shows right coronary artery (striped arrow) originating from right sinus of Valsalva and coursing in right atrioventricular groove and long LAD (black arrows) originating from right sinus of Valsalva following anomalous transseptal course and emerging in anterior interventricular groove. Short LAD (not shown) originated from left sinus of Valsalva. Narrow caliber of long LAD is evident. Retroaortic LCX (notched arrow) gives rise to large functional diagonal branch (curved arrow).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —54-year-old man with type 4 dual left anterior descending coronary artery (LAD) and anomalous left circumflex coronary artery (LCX). Oblique maximum-intensity-projection image shows anomalous long LAD (black arrow) and proximal portion of LCX (white arrow) also originating from right sinus of Valsalva.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —54-year-old man with type 4 dual left anterior descending coronary artery (LAD) and anomalous left circumflex coronary artery (LCX). Axial maximum-intensity-projection image shows short LAD (arrow) originating from left sinus of Valsalva.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —54-year-old man with type 4 dual left anterior descending coronary artery (LAD) and anomalous left circumflex coronary artery (LCX). Axial maximum-intensity-projection image shows anomalous LCX (notched arrows) taking retroaortic course before entering left atrioventricular groove. Striped arrow indicates right coronary artery.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —54-year-old man with type 4 dual left anterior descending coronary artery (LAD) and anomalous left circumflex coronary artery (LCX). Volume-rendered images show type 4 LAD, that is, anomalous long LAD (long black arrow, E) originating from right sinus of Valsalva and following transseptal course and short LAD (short black arrow, E) originating from left sinus of Valsalva and retroaortic LCX (notched arrow). LCX gives rise to large functional diagonal branch (curved arrow, E). Striped arrow indicates right coronary artery.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —54-year-old man with type 4 dual left anterior descending coronary artery (LAD) and anomalous left circumflex coronary artery (LCX). Volume-rendered images show type 4 LAD, that is, anomalous long LAD (long black arrow, E) originating from right sinus of Valsalva and following transseptal course and short LAD (short black arrow, E) originating from left sinus of Valsalva and retroaortic LCX (notched arrow). LCX gives rise to large functional diagonal branch (curved arrow, E). Striped arrow indicates right coronary artery.

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