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LETTER TO THE EDITOR  
Year : 2017  |  Volume : 27  |  Issue : 3  |  Page : 362-363
Comment on: Dual LAD with anomalous origin of long LAD from right coronary sinus: A variant of type VI LAD


1 Department of Radiology, Fortis Hospital, Mohali, Punjab, India
2 Intensive Care, Max Hospital, Mohali, Punjab, India

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Date of Web Publication25-Sep-2017
 

How to cite this article:
Prasad A, Sinha S, Brar R, Rana S. Comment on: Dual LAD with anomalous origin of long LAD from right coronary sinus: A variant of type VI LAD. Indian J Radiol Imaging 2017;27:362-3

How to cite this URL:
Prasad A, Sinha S, Brar R, Rana S. Comment on: Dual LAD with anomalous origin of long LAD from right coronary sinus: A variant of type VI LAD. Indian J Radiol Imaging [serial online] 2017 [cited 2020 Jul 2];27:362-3. Available from: http://www.ijri.org/text.asp?2017/27/3/362/215582
Sir,

We read with great interest the article by Vohra et al. published in May 2016 issue of IJRI.[1] We congratulate the authors on reporting an extremely rare variant of dual left anterior descending artery (LAD). We would also like to report an interesting variant of dual LAD, which we recently diagnosed in a patient.

A 50-year-old gentleman was referred to our department for computed tomography (CT) coronary angiography with complaints of pain on the left side of the chest and cold sweats since 4 days. CT coronary angiography, done on a 64-slice CT (Somatom Sensation-64, Erlangen, Germany), showed evidence of dual LAD. The short LAD was arising from the left main coronary artery and coursing in the proximal anterior interventricular groove and terminated after giving a large septal and one large diagonal branch. The long LAD was found arising from the right coronary sinus in close proximity to the right coronary artery (RCA) ostium [Video 1]. It showed epicardial course between the aortic root and right ventricular outflow tract (RVOT) and reached the mid anterior interventricular groove [Figure 1] and [Figure 2]. No significant disease was noted in either LAD; however, severe plaque-induced narrowing was found in the large diagonal arising from short LAD.
Figure 1: Oblique maximum intensity projection (MIP) CT Coronary Angiography image shows the short LAD (bold arrow) arising from the left main coronary artery and terminating in the proximal anterior interventricular groove. The long LAD (open arrow) arising from the right coronary sinus adjacent to the RCA ostium and coursing between the RVOT and aortic root

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Figure 2: Three dimensional volume rendered (VRT) CT Coronary Angiography image shows the long LAD (open arrow) arising from the right coronary sinus and entering the mid anterior interventricular groove. The short LAD from left main coronary artery is terminating (bold arrow) after giving large diagonal and septal branches.

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Dual LAD were first classified into four types by Spindola-Franco et al.,[2] however, many other variants of dual LAD have been added since then. A recent article by Celik et al. mentioned ten types of dual LAD.[3] Our case does not fit exactly in any of the described types, however, it is similar to the one described as type VI LAD which was reported by Maroney and Klein,[4] in which the long LAD arises from the RCA and shows an interarterial course between the aortic root and RVOT. However, our case is different from the classic type VI LAD as in our case the long LAD was arising from the right coronary sinus and not from the RCA, as noted in their case. Hence, this variant of LAD can be classified as type VIa LAD where the long LAD arises from the right coronary sinus and shows an interarterial course between the aortic root and RVOT. We could find only one previously described case of similar type of dual LAD.[5]

Our case adds to the database of ever increasing types of dual LAD and emphasizes the need for carefully outlining the course and number of LAD on CT coronary angiograms so that significant anomalies are not missed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Vohra A, Narula H. Dual left anterior descending artery with anomalous origin of long LAD from pulmonary artery - rare coronary anomaly detected on computed tomography coronary angiography. Indian J Radiol Imaging 2016;26:201-5.  Back to cited text no. 1
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2.
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;105:445-55.  Back to cited text no. 2
[PUBMED]    
3.
Celik T, Bozlar U, Ozturk C, Balta S, Verim S, Demir M, et al. A new anomaly of the left anterior descending artery: Type X dual LAD. Indian Heart J 2015;67:14-7.  Back to cited text no. 3
    
4.
Maroney J, Klein LW. Report of a new anomaly of the left anterior descending artery: Type VI dual LAD. Catheter Cardiovasc Interv 2012;80:62-69.  Back to cited text no. 4
[PUBMED]    
5.
Deora S, Kumar T, Shah S, Patel T. Reporting a novel variant of type VI dual left anterior descending artery: A rare coronary anomaly. BMJ Case Reports 2015;2015. pii: Bcr2015211128.  Back to cited text no. 5
    

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Correspondence Address:
Abhishek Prasad
Department of Radiology, Fortis Hospital, Mohali, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijri.IJRI_369_16

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