Dual left anterior descending coronary artery

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A dual left anterior descending coronary arteries are a group of rare variants of the left anterior descending artery. Almost all dual variants have short and long LAD branches.

Subtypes

Several (up to 9) subtypes have been described including the 4 initial types originally described by Spindola-Franco et al.

These include

  • type I: 
    • considered commonest
    • both left-main and LAD proper present
    • short LAD originates from the LAD proper and terminates in the proximal anterior interventricular sulcus
    • long LAD originates from the LAD proper, courses on LV side of the proximal anterior interventricular sulcus and reenters the distal anterior interventricular sulcus
  • type II:​
    • both left-main and LAD proper present
    • short LAD originates from the LAD proper and terminates in the proximal anterior interventricular sulcus
    • long LAD originates from the LAD proper, courses on LV side of the proximal anterior interventricular sulcus and reenters the distal anterior interventricular sulcus
  • type III:
    • both left-main and LAD proper present
    • short LAD originates from the LAD proper and terminates in the proximal anterior interventricular sulcus
    • long LAD originates from the LAD proper, follows an intramyocardial course in the septum proximally, emerges epicardially in the distal anterior interventricular sulcus (or does not emerge in the anterior interventricular sulcus and terminated, intramyocardially)
  • type IV:
    • left-main present but LAD proper absent
    • short LAD originates from the LAD proper and terminates in the proximal anterior interventricular sulcus
    • long LAD originates from the proximal right coronary artery (RCA), follows an anomalous pre-pulmonic course anterior to the RVOT, and enters the distal anterior interventricular sulcus
  • type V:
    • both left-main and LAD proper absent
    • short LAD originates from the left coronary sulcus, terminates in the proximal anterior interventricular sulcus
    • long LAD originates from the proximal right coronary sulcus, follows an anomalous intramyocardial course within the septal crest, emerges epicardially, and enters the distal anterior interventricular sulcus
  • type VI:
    • left-main present but LAD proper absent
    • short LAD originates from the left main and terminates in the proximal anterior interventricular sulcus
    • long LAD originates from proximal RCA, follows an anomalous course between the RVOT and the aortic root, and enters the distal anterior interventricular sulcus
  • type VII:
    • both left-main and LAD proper present
    • left-main originates from the right coronary sulcus and shows inter-arterial malignant course
    • short LAD originates from the LAD proper, terminates in the proximal anterior interventricular sulcus
    • long LAD originates from the LAD proper, courses on LV side of the proximal anterior interventricular sulcus, and reenters the distal anterior interventricular sulcus
  • type VIII:
    • left-main present but LAD proper absent
    • left-main originates from the right coronary sulcus and shows retro aortic course
    • short LAD originates from the left-main, terminates in the proximal anterior interventricular sulcus
    • long LAD originates from the mid-RCA, courses inferior wall surface of the RV, then turns around the apex, and reaches to the distal anterior interventricular sulcus
  • type IX: (triple LAD)
    • both left-main and LAD proper present
    • short LAD originates from the LAD proper, terminates in the mid-anterior interventricular sulcus
    • long LAD originates from the LAD proper, courses on LV side of the mid anterior interventricular sulcus, reenters the distal anterior interventricular sulcus and terminates before reaching to the apex