|Year : 2017 | Volume
| Issue : 2 | Page : 169-170
Dual left anterior descending artery with anomalous origin of left anterior descending artery from pulmonary artery: A rare anomaly
Bhupinder Singh, Rohit Tandon, Bishav Mohan, Gurpreet Singh Wander
Consultant Cardiology, Hero DMC Heart Institute, Ludhiana, Punjab, India
|Date of Web Publication||28-Aug-2017|
Hero DMC Heart Institute, Tagore Nagar, Ludhiana - 141 001, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh B, Tandon R, Mohan B, Wander GS. Dual left anterior descending artery with anomalous origin of left anterior descending artery from pulmonary artery: A rare anomaly. J Indian Acad Echocardiogr Cardiovasc Imaging 2017;1:169-70
|How to cite this URL:|
Singh B, Tandon R, Mohan B, Wander GS. Dual left anterior descending artery with anomalous origin of left anterior descending artery from pulmonary artery: A rare anomaly. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2017 [cited 2020 Sep 29];1:169-70. Available from: http://www.jiaecho.org/text.asp?2017/1/2/169/213673
A 23 year old female was referred to for evaluation of left side chest pain on moderate exertion for 3 months. Her general and systemic physical examination was unremarkable. Electrocardiogram [Figure 1]a showed T wave inversions in lead V1–V3. Cardiac shadow was normal on chest roentgenogram [Figure 1]b. Transthoracic echocardiography showed normal left ventricular size and functions and no shunts or valvular lesion or pericardial pathology. Parasternal short axis view revealed a mildly dilated right coronary artery (RCA) in normal position. Color Doppler interrogation showed a vascular channel draining into the main pulmonary artery (MPA) adjacent to the pulmonary valve [Figure 1]c, which on pulse Doppler [Figure 1]d showed predominant diastolic flow into the MPA. This was further confirmed on the three dimensional (3D) color coded duplex sonography [Figure 1]e using Q Lab software to acquire 3D color data set and subsequently keeping only color Doppler data in which only color flow in vessels is seen while other myocardial structures are hidden. After obtaining informed consent, the patient was taken up for cardiac catheterization study which showed an insignificant left to right shunt. Coronary angiography revealed a massively dilated left anterior descending artery (LAD) originating from the MPA. Right coronary angiogram [Figure 1]f showed a dilated RCA giving large feeding collateral to anomalous LAD. Left coronary angiogram [Figure 1]g showed left circumflex and rudimentary LAD both arising from the left main coronary artery and giving collateral to anomalous LAD. Pulmonary root angiogram [Figure 1]h also showed the retrograde filling anomalous LAD. Stress thallium revealed a mild apical perfusion defect. The patient was kept on medical management. This case represents a rare coronary anomaly; dual LAD with anomalous origin of main LAD from pulmonary artery in a young adult female which was suspected on 3D color coded duplex sonography and subsequently confirmed by conventional coronary angiography. Pulmonary origin of the LAD is a very rare coronary artery anomaly with a frequency of 0.0008%. Natural history of this anomaly is unknown may lead to myocardial ischemia and sudden cardiac death.,,
|Figure 1: Electrocardiogram (a) showing precordial T-wave inversion and roentgenogram (b) normal cardiac shadow. Color comparison (c) across the main pulmonary artery revealing a large vascular channel (green arrow) draining into it which shows a predominantly diastolic flow on Doppler interrogation (d). Three-dimensional color-coded duplex sonography with (green arrow) (e) confirming it further. Coronary angiography (f) demonstrating large and tortuous right coronary artery giving feeding collaterals to anomalous left anterior descending artery (black arrows) draining into the main pulmonary artery. Left coronary shoot revealing small left anterior descending artery (arrow heads) and left circumflex; both originating from short left main coronary artery giving collaterals to the anomalous left anterior descending artery. Pulmonary artery angiogram (g) revealing the anomalous left anterior descending artery originating from it|
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