Type X dual left anterior descending (LAD) artery masquerading as type 1 LAD — a case report
Autor: | Manphool Singhal, Anish Bhargav, Parminder S Otaal |
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Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Left anterior descending artery 030204 cardiovascular system & hematology Asymptomatic 030218 nuclear medicine & medical imaging Angina 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery Dual medicine cardiovascular diseases Interventricular septum Variant business.industry New variant medicine.disease RC31-1245 surgical procedures operative medicine.anatomical_structure Right coronary artery cardiovascular system Cardiology Inducible ischemia Aberrant medicine.symptom business Stenotic lesion circulatory and respiratory physiology Artery |
Zdroj: | The Egyptian Journal of Internal Medicine, Vol 33, Iss 1, Pp 1-6 (2021) |
ISSN: | 2090-9098 1110-7782 |
DOI: | 10.1186/s43162-021-00053-0 |
Popis: | Background Dual left anterior descending (LAD) coronary artery is a rare congenital anomaly. To date, eleven variants of dual LAD have been described with three published reports of type X dual LAD. Here, we describe a new variant of type X dual LAD with a short LAD artery masquerading as type 1 LAD. Case presentation A 42-year hypertensive female presented with recent onset angina with a treadmill test positive for inducible ischemia. Coronary angiography showed a normal right coronary artery (RCA). The left main coronary artery (LMCA) originated from the left sinus of Valsalva (SOV), giving rise to a LAD and the left circumflex artery (LCX). Appearing a normal angiogram with type 1 LAD based on its length, the presence of a large bare area in LAD territory (especially at the apex) and lack of septal branches prompted a search for an additional vessel. Right SOV injection showed a vessel originating separately from RCA, which was confirmed to be a long LAD on selective injection, with a pre-pulmonic course and giving rise to septal branches exclusively before wrapping around the apex. Computed tomography coronary angiography (CTCA) confirmed the pre-pulmonic course of long LAD, defined its entry to the distal interventricular septum to the right of short LAD, and ruled out other coronary artery anomalies. In the absence of a stenotic lesion in the epicardial coronaries, angina in our case was presumed to be due to microvascular dysfunction. She was discharged on beta-blocker therapy for co-existing hypertension and is asymptomatic on follow-up at one year. Conclusions A short LAD artery of type X Dual LAD could be potentially misdiagnosed as type 1 LAD based on its length. However, an active search for a long LAD could properly diagnose the case as a variant of type X dual LAD, which has important clinical implications. Its awareness is critical for cardiologists and cardiac surgeons to correctly interpret the coronary angiogram and plan proper management. |
Databáze: | OpenAIRE |
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