Abstract
Duplication of the left anterior descending artery is an uncommon coronary anomaly. Since no proper classification has been established after the initial description and numerical classification by Spindola-Franco et al., many newer numbers have evolved with many overlapping and unclassified variants described in the literature. Identification and reasonable management strategies for dual left anterior descending artery (LAD) are crucial in preventing the long-term disastrous consequences of inadequate revascularization. Clinicians and diagnosticians should be aware of this specific angiographic-based congenital coronary abnormality of the LAD. We, therefore, sought a new, reasonable classification of the dual LAD system, which would clarify this ambiguity, which also has therapeutic implications.
Similar content being viewed by others
References
Tuncer C, Batyraliev T, Yilmaz R, Gokce M, Eryonucu B, Koroglu S. Origin and distribution anomalies of the left anterior descending artery in 70,850 adult patients: Multicenter data collection. Catheter Cardiovasc Interv. 2006;68:574–85.
Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Catheter Cardiovasc Diagn. 1990;21:28–40.
Saremi F, Shavelle D. Dual origin, course and supply in coronary artery system. Int J Cardiol. 2013;168:4970–4.
Bozlar U, Uğurel MS, Sarı S, Akgün V, Örs F, Tasar M. Prevalence of dual left anterior descending artery variations in CT angiography. Diagn Interv Radiol. 2015;21:34–41.
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.
Sidhu NS, Wander GS. Prevalence and characteristics of dual left anterior descending artery in adult patients undergoing coronary angiography. Futur Cardiol. 2019;15:425–35.
Angelini P. Coronary artery anomalies: An entity in search of an identity. Circulation. 2007;115:1296–305.
Greenberg MA, Spindola‐Franco H. Dual left anterior descending coronary artery (dual LAD). Catheter Cardiovasc Diagn. 1994;31:250–3.
Jariwala P, Padma Kumar EA. Hyper-dominant left anterior descending coronary artery with continuation as a posterior descending artery—An extended empire. J Saudi Heart Assoc. 2018;30:284–9.
Waterson O, Orr J, Cappell DF. Sir James Mackenzie’s heart. Br Heart J. 1939;1:237–8.
Voudris V, Salachas A, Saounotsou M, et al. Double left anterior descending artery originating from the left and right coronary artery: A rare coronary artery anomaly. Catheter Cardiovasc Diagn. 1993;30:45–7.
Manchanda A, Qureshi A, Brofferio A, Go D, Shirani J. Novel variant of dual left anterior descending coronary artery. J Cardiovasc Comput Tomogr. 2010;4:139–41.
Moulton KM, Kraushaar G, Fladeland DA. An unusual case of dual left anterior descending artery with coronary computed tomographic angiographic correlation. Case Rep Radiol. 2013;2013:1–3.
Maroney J, Klein LW. Report of a new anomaly of the left anterior descending artery: Type VI dual LAD. Catheter Cardiovasc Interv. 2012;80:626–9.
Montero-Cabezas JM, Tohamy AM, Karalis I, Delgado V, Schalij MJ. The descending septal artery: description of this infrequent coronary anatomical variant in three different clinical scenarios. Rev Esp Cardiol. 2015;68:1029–31.
Moreno-Martínez FL, Aladro-Miranda IF, Ibargollín-Hernández RS, et al. Circumflex angioplasty in a patient with type IV dual left anterior decending coronary artery. Proposal for updating the classification of Spindola- Franco. Arch Cardiol Mex. 2012;82:297–302.
Moreno-Martínez FL, Spindola-Franco H, López-Bernal OJ. Could descending septal artery be another variant of the dual left anterior descending artery? Rev Esp Cardiol. 2016;69:458–60.
Subban V, Murdoch D, Pincus M. Dual left anterior descending coronary artery with origin of short left anterior descending coronary artery from left main shaft - A rare coronary anomaly. J Invasive Cardiol. 2014;26:E59–60.
Dhanse S, Kareem H, Sudhakar Rao M, Devasia T. Dual LAD system – a case report and lessons learnt from past nomenclature system. IHJ Cardiovasc Case Rep. 2018;2:S4–7. Available from: https://doi.org/10.1016/j.ihjccr.2018.06.002.
Celik T, Bozlar U, Ozturk C, et al. A new anomaly of the left anterior descending artery: Type X dual LAD. Indian Heart J. 2015;67:S14–7.
Al-Umairi RS, Al-Kindi FA, Al-Tai SA. A new variant of dual left anterior descending artery anomaly type XI. Sultan Qaboos Univ Med J. 2018;18:e386–8.
Pandey NN, Shaw M, Sharma A, Ganga KP, Gulati GS. Yet another novel variant of dual left anterior descending artery: type XII. Heart Lung Circ. 2020;29:e33–5. Available from: https://doi.org/10.1016/j.hlc.2019.07.022.
Abbasov Eyvaz SM, Fuad A. Dual LAD – contemporary review. J Cardiol Curr Res. 2015;3:2–4.
Celik M, Iyisoy A, Celik T. A coronary artery anomaly: Type IV dual left anterior descending artery. Cardiovasc J Afr. 2010;21:223–4.
Angelini P. Coronary artery anomalies - current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Texas Heart Inst J. 2002;29:271–8.
Yokokawa T, Watanabe K, Sakamoto T, Ohwada T, Takeishi Y. Importance of multi-detector computed tomography for percutaneous coronary intervention in a patient with type V dual left anterior descending artery. J Cardiol Cases. 2012;6:e100–2. Available from: https://doi.org/10.1016/j.jccase.2012.06.010.
Şeker M. Prevalence and morphologic features of dual left anterior descending artery subtypes in coronary CT angiography. Radiol Med. 2020;125:247–56.
Shizukuda Y, Effat M. A new variation of dual left anterior descending coronary artery. J Cardiol Cases. 2016;14:26–8.
Soman B. Coronary artery anomaly: Rare and anomalous branching of left coronary artery. Heart India. 2016;4:33.
Sayin MR, Akpinar I, Karabag T, Dogan SM, Aydin M. A typical type of dual left anterior descending coronary artery. J Cardiol Cases. 2013;8:e39–41.
Cusco JA, Delehanty JM, Ling FS. Trifurcation triple balloon angioplasty in a dual left anterior descending coronary artery: The “ménage à trois” revisited. Cathet Cardiovasc Diagn. 1996;38:214–7.
Jariwala P, Sunnadkal R. Type 9 dual left anterior descending artery or triple left anterior descending artery anomaly: A rare anomaly. J Indian Acad Echocardiogr Cardiovasc Imaging. 2019;3:99.
Bildirici U, Kilic T, Ural D, Bulut O, Ural E. Combined congenital coronary artery anomaly: dual left anterior descending coronary artery and absence of left circumflex artery. Anadolu Kardiyol Derg. 2011;11:180–1. Available from: https://doi.org/10.5152/akd.2011.042.
El Tallawi KC, Saade C, AlJaroudi W, Abchee A. Coronary computed tomography: Identification of a novel type of dual left anterior decending coronary artery circulation. J Clin Exp Cardiolog. 2015;06:6–8.
Deora S, Kumar T, Shah SC, et al. Reporting a novel variant of type VI dual left anterior descending artery: A rare coronary anomaly. BMJ Case Rep. Available from: https://doi.org/10.1136/bcr-2015-211128.
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. Available from: http://www.ijri.org/text.asp?2017/27/3/362/215582.
Kunimoto S, Sato Y, Kunimasa T, et al. Double left anterior descending artery arising from the left and right coronary arteries: Depiction at multidetector-row computed tomography. Int J Cardiol. 2009;132:e54–6.
Cho JS, Kim J, Yoon SP. Dual left anterior interventricular coronary artery with a rare course in a Korean. Anat Cell Biol. 2015;48:144–6.
Nasrin S, Cader FA, Haq MM, Shafi MJ. Type IV dual left anterior descending coronary artery: A case report. BMC Res Notes. 2017;10:1–4.
Bali HK, Chattree K, Bali SK, Chauhan HKC, Shukla CP. PCI in a case of dual (type IV) LAD with anomalous origin of the LCx from RCA. J Saudi Heart Assoc. 2014;26:43–6.
Bittner V, Nath HP, Cohen M, Soto B. Dual connection of the left anterior descending coronary artery to the left and right coronary arteries. Catheter Cardiovasc Diagn. 1989;16:168–72.
Chang CJ, Cheng NJ, Ko YS, Ko YL, Chiang CW. Dual left anterior descending coronary artery and anomalous aortic origin of the left circumflex coronary artery: A rare and complicated anomaly. Am Heart J. 1997;133:598–601.
Daralammouri Y, Ghannam M, Lauer B. New congenital coronary artery anomaly - Double supply of single left anterior descending coronary artery from the left and right coronary sinuses: A case report. J Med Case Rep. 2016;10:1–3.
Turkoglu S, Balcioglu S, Ozdemir M. Type IV dual left anterior descending artery associated with anomalous origin of the left circumflex coronary artery from the right coronary artery: A case report. J Invasive Cardiol. 2008;20:669–70.
Santosh A, Sinha K, Krishna V, Himanshu K. Dual left anterior descending artery with abberrent left circumflex artery: dual abberrency- a multi-modality imaging based identification. Folia Cardiol. Available from: https://doi.org/10.5603/FC.a2018.0058.
Moreno-Martínez FL, Cuesta J, Rivero F, Alfonso F, Benedicto A, Pozo-Osinalde E. Y-shaped dual left anterior descending artery or coronary collateral circulation? Rev Esp Cardiol.2019;72:346–348. Available from: https://linkinghub.elsevier.com/retrieve/pii/S188558571830197X. Acessed 24/11/2020.
DeSimone CV, Williamson E, Schaff HV, Barsness GW, Hoffman SJ, Mathew V. Single coronary artery arising from the right aortic sinus with dual LAD supply from separate branches. Euro Intervention. 2017;12:2157.
Tuncer C, Gumusalan Y, Sokmen A, Sokmen G, Koroglu S, Suner A. A previously undescribed anomaly of left anterior descending artery: Type V dual left anterior descending artery. Int J Cardiol. 2009;134:e141–3.
Barbaryan A, Addai T, Kola M, Raqeem MW, Barsamyan S, Mirrakhimov AE. A combination of two rare coronary anomalies makes it even rarer: right sided single coronary artery with dual left anterior descending artery. Case Reports Cardiol. 2016;2016:1–4.
Vora K. Atherosclerotic coronary artery disease in single coronary artery with dual LAD:a rarecase of diagnostic challenge. J Cardiovasc Comput Tomogr. 2019;13:S1.
Cingoz F, Arslan G, Iyisoy A, Bingol H. Novel variant of dual left anterior descending artery arising from single right coronary artery anomaly presenting with angina inversa. Kardiochir Torakochirurgia Pol. 2015;12:246–7.
Matsumoto M, Yokoyama K, Yahagi T, et al. Double left anterior descending artery arising from right and left sinus of Valsalva in patient with acute coronary syndrome. Int J Cardiol. 2011;149:e40–e42. Available from: https://doi.org/10.1016/j.ijcard.2009.03.049.
Acknowledgments
We thank Mr. Naveen Rao, Mr. Srinivas Rao, Mr. Bhaskar, and Tony Anthony for their technical assistance.
Funding
There is no source of funding for this article.
Author information
Authors and Affiliations
Contributions
All the authors contributed to conceptualization, data curation, formal analysis, investigation, methodology, software, supervision, validation, roles/writing—original draft, and writing—review and editing.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from a participant included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jariwala, P., Jadhav, K.P. & Koduganti, S. Dual left anterior descending artery: diagnostic criteria and novel classification. Indian J Thorac Cardiovasc Surg 37, 285–294 (2021). https://doi.org/10.1007/s12055-020-01102-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12055-020-01102-z