A case of dual left anterior descending artery with myocardial infarction

Dheeraj, Abhaykumar Binodkumar; Giri, Sandeep Kumar; Ghormade, Pankaj Suresh

doi:10.4322/acr.2020.223

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Autopsy Case Report and Review • Autops. Case Rep. 10 (4) • 2020 • https://doi.org/10.4322/acr.2020.223 linkcopy

A case of dual left anterior descending artery with myocardial infarction

Authorship SCIMAGO INSTITUTIONS RANKINGS

The Left anterior descending artery (LAD) is a branch of the left main coronary artery which runs obliquely towards the apex of the heart in the anterior interventricular sulcus. Among all of the coronary arteries, the LAD artery has the most constant course. Amongst the anomalies of coronaries, the duplication or bifurcation of the LAD artery is infrequent. The classification of the bifurcation of the LAD has been extensively described in various reports with the widespread use of CT Angiography. We describe herein, an anomalous LAD detected on autopsy. This unusual case highlights the gross autopsy finding of Type-I anomalous dual LAD coronary artery in a young adult who died of Myocardial Infarction.

Keywords
Anomalous Left Coronary artery; Myocardial Infarction; Autopsy

Type of dual LAD	LAD Proper	Short LEFT ANTERIOR DESCENDING ARTERY		Long LAD
Type of dual LAD	LAD Proper	Origin	Termination	Origin	Course and Location
Type-1³	Present	From LAD proper	In proximal AIVS	From LAD proper	In proximal AIVG epicardially on LV side, re-enters the distal AIVS
Type-2³	Present	From LAD proper	In proximal AIVS	From LAD proper	In proximal AIVG epicardially on RV side, re-enters the distal AIVS
Type-3³	Present	From LAD proper	In proximal AIVS	From LAD proper	In proximal AIVG intramyocardially, re-enters epicardially in the distal AIVS
Type-4³	Absent	From LMCA	In proximal AIVS	From RCA	In proximal AIVS epicardially along anterior to RVOT, re-enters epicardially in the distal AIVS
Type-5⁵	Absent	From LCS	In proximal AIVS	From RCS	Intramyocardially within septal crest, re-enters epicardially in the distal AIVS
Type-6⁶	Absent	From LMCA	In proximal AIVS	From RCA	Epicardially between RVOT and aortic root, continuing to distal AIVS
Type-7⁷	Absent	From LMCA	In proximal AIVS	From RCS	Intramyocardially in septal crest, emerging epicardially in distal AIVS
Type-8²	Absent	From LMCA	In proximal AIVS	From mid RCA	Epicardially in inferior surface of RV, re-enters epicardially in the distal AIVS
Type-9²	Present	From LAD proper	In mid AIVS	From LAD proper	Epicardially on LV side, re-enters epicardially in the distal &terminates before reaching the apex.

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[1] AIVS: anterior interventricular sulcus; AIVG: anterior interventricular groove; LAD: left anterior descending artery; LMCA: left main coronary artery; LV: left ventricle; RCA: right coronary artery; RV: right ventricle; RVOT: right ventricular outflow tract; RCS: right coronary sinus.