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Cardiac
Diagnosis
Coronary Artery Disease
Duplicate LAD
Duplicate LAD
Prabhakar Rajiah, MBBS, MD, FRCR, FSCMR; Prachi P. Agarwal, MD
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Abbreviations

        • Duplicate left anterior descending (LAD) coronary artery 

      • Synonyms

        • Dual left anterior descending (LAD) coronary artery

      • Definitions

        • Rare congenital coronary artery anomaly with 2 LADs: 1 short, 1 long
        • Short LAD usually originates from LAD proper and terminates high in proximal anterior interventricular vein (AIV) groove
        • Long LAD has variable origin from either left or right coronary arteries, has variable course outside proximal AIV groove, and reenters distal part of AIV groove to reach cardiac apex
          • Note that normally, LAD originates from left main coronary artery (LMCA), courses in AIV groove, and gives off diagonal and septal perforators

      IMAGING

      • General Features

        • CT Findings

          • MR Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Presentation

                    • Natural History & Prognosis

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          • Reporting Tips

                            Selected References

                            1. Lee YF et al: A rare coronary anomaly -- type 4 dual left anterior descending artery accompanying anomalous origin of the left coronary artery from the right coronary sinus. J Cardiovasc Comput Tomogr. ePub, 2019
                            2. Bali HK et al: PCI in a case of dual (type IV) LAD with anomalous origin of the LCx from RCA. J Saudi Heart Assoc. 26(1):43-6, 2014
                            3. Ghandour A et al: Unusual fistulas and connections in the cardiovascular system: A pictorial review. World J Radiol. 6(5):169-76, 2014
                            4. Lee Y et al: A case report of type VI dual left anterior descending coronary artery anomaly presenting with non-ST-segment elevation myocardial infarction. BMC Cardiovasc Disord. 12:101, 2012
                            5. Maroney J et al: Report of a new anomaly of the left anterior descending artery: type VI dual LAD. Catheter Cardiovasc Interv. 80(4):626-9, 2012
                            6. Manchanda A et al: Novel variant of dual left anterior descending coronary artery. J Cardiovasc Comput Tomogr. 4(2):139-41, 2010
                            7. Agarwal PP et al: Dual left anterior descending coronary artery: CT findings. AJR Am J Roentgenol. 191(6):1698-701, 2008
                            8. Chiurlia E et al: Type IV dual left anterior descending coronary artery evaluated using multislice computed tomography: anatomy of a rare coronary anomaly. Ital Heart J. 4(12):900-1, 2003
                            9. Sajja LR et al: Dual left anterior descending coronary artery: surgical revascularization in 4 patients. Tex Heart Inst J. 27(3):292-6, 2000
                            10. Spindola-Franco H et al: Dual left anterior descending coronary artery: angiographic description of important variants and surgical implications. Am Heart J. 105(3):445-55, 1983
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                TERMINOLOGY

                                • Abbreviations

                                  • Duplicate left anterior descending (LAD) coronary artery 

                                • Synonyms

                                  • Dual left anterior descending (LAD) coronary artery

                                • Definitions

                                  • Rare congenital coronary artery anomaly with 2 LADs: 1 short, 1 long
                                  • Short LAD usually originates from LAD proper and terminates high in proximal anterior interventricular vein (AIV) groove
                                  • Long LAD has variable origin from either left or right coronary arteries, has variable course outside proximal AIV groove, and reenters distal part of AIV groove to reach cardiac apex
                                    • Note that normally, LAD originates from left main coronary artery (LMCA), courses in AIV groove, and gives off diagonal and septal perforators

                                IMAGING

                                • General Features

                                  • CT Findings

                                    • MR Findings

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          PATHOLOGY

                                          • General Features

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Natural History & Prognosis

                                                • Treatment

                                                  DIAGNOSTIC CHECKLIST

                                                  • Consider

                                                    • Reporting Tips

                                                      Selected References

                                                      1. Lee YF et al: A rare coronary anomaly -- type 4 dual left anterior descending artery accompanying anomalous origin of the left coronary artery from the right coronary sinus. J Cardiovasc Comput Tomogr. ePub, 2019
                                                      2. Bali HK et al: PCI in a case of dual (type IV) LAD with anomalous origin of the LCx from RCA. J Saudi Heart Assoc. 26(1):43-6, 2014
                                                      3. Ghandour A et al: Unusual fistulas and connections in the cardiovascular system: A pictorial review. World J Radiol. 6(5):169-76, 2014
                                                      4. Lee Y et al: A case report of type VI dual left anterior descending coronary artery anomaly presenting with non-ST-segment elevation myocardial infarction. BMC Cardiovasc Disord. 12:101, 2012
                                                      5. Maroney J et al: Report of a new anomaly of the left anterior descending artery: type VI dual LAD. Catheter Cardiovasc Interv. 80(4):626-9, 2012
                                                      6. Manchanda A et al: Novel variant of dual left anterior descending coronary artery. J Cardiovasc Comput Tomogr. 4(2):139-41, 2010
                                                      7. Agarwal PP et al: Dual left anterior descending coronary artery: CT findings. AJR Am J Roentgenol. 191(6):1698-701, 2008
                                                      8. Chiurlia E et al: Type IV dual left anterior descending coronary artery evaluated using multislice computed tomography: anatomy of a rare coronary anomaly. Ital Heart J. 4(12):900-1, 2003
                                                      9. Sajja LR et al: Dual left anterior descending coronary artery: surgical revascularization in 4 patients. Tex Heart Inst J. 27(3):292-6, 2000
                                                      10. Spindola-Franco H et al: Dual left anterior descending coronary artery: angiographic description of important variants and surgical implications. Am Heart J. 105(3):445-55, 1983