Dual LAD system – A case report and lessons learnt from past nomenclature system

Abstract

A dual left anterior descending artery (LAD) system where the short LAD arises from the left main coronary artery (LMCA) directly, while the long LAD arises from the bifurcation of the LMCA, is a rare finding. Our patient, a 45-year-old lady, presented with angina at rest and underwent a coronary angiogram. The angiogram showed a normal right coronary artery (RCA). The LMCA gave rise to the short LAD, which entered the interventricular groove and provided septal branches. The LMCA terminated in a bifurcation, which gave rise to the long LAD (which supplied diagonal branches) and the left circumflex artery (LCX). This configuration has only been reported once in literature and has been dubbed Type VII dual LAD system. In the other six types of dual LAD systems, the short LAD and long LAD, either both arise from a branch of the LMCA (types I-III) or from the LMCA and RCA, respectively (types IV-VI). Through this report, we emphasize the importance of a single and standard nomenclature for dual LAD system.