PMC5110557_01
Selective left coronary angiography shows a short LAD (arrowheads) originating from the left main coronary artery (arrow), giving rise to septal branches and diagonal artery branches (A). Selective right coronary angiography reveals a dominant RCA (white arrow) without any additional vascular anomalies (B). Attempted recanalization of the distal portion of the short LAD was unsuccessful.
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F1
The angiogram showed occlusion of the distal left anterior descending artery (LAD), with a severe ostial lesion of the second diagonal branch (Figure 1A). The left circumflex and the right coronary artery (Figure 1B) presented no significant lesion.
An anterior projection of a three-dimensional volume-rendered computed tomography image confirms the short LAD (black arrowheads) originating from the left main coronary artery terminating its course in the interventricular sulcus. Additionally, a long LAD (white arrowheads) is visualized originating above the right coronary artery sinus initially pointed cranially, then traveling anteriorly to the interventricular sulcus and finally descending toward the apex (A). Axial computed tomography image demonstrates a long LAD epicardial course (arrowheads) as it passes anteriorly to the right ventricular outflow track, consistent with a Spindola-Franco class IV dual LAD (B).
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The anomalous distal LAD originated from the right coronary sinus with a prevascular course easily appreciated in the 3D reconstructions (Figures 2A,B).