A Previously Undescribed Complex Coronary Artery Anomaly
We present the case of a 54 years old woman, who was a smoker and was affected by obesity, type 1 diabetes, and hypertension. Eight years before, she had undergone surgical aortic valve replacement with mechanical aortic valve. The patient was admitted to hospital to perform elective surgery for ascending aortic aneurysm. In the last 6 months, she experienced several episodes of typical angina and chest tightness not related to exertion or emotional stress. Echocardiography showed global and regional left ventricular contractile function (left ventricular ejection fraction 56%), mild mitral and tricuspid regurgitation, and ascending aortic aneurysm with maximum diameter of 71 mm. Blood biochemical parameters were within normal range. Electrocardiogram showed T-waves’ inversion in anterior and lateral leads. Before surgery, the patient was in coronary angiography (CA).\nAt CA, there was no significant coronary artery stenosis or dynamic obstructions, but we incidentally found a congenital coronary anomaly in the form of peculiar dual left anterior descending artery (LAD) anatomy. LAD arising from the left sinus of Valsalva was short and gave rise to one septal branch, a little intermedius branch, and one diagonal branch []. The left circumflex artery (LCX) was aplastic [] and the right coronary artery (RCA) was dominant and normal in origin and course [Figures and ]. A second LAD was seen arising from the right sinus of Valsalva, with a third ostium different from RCA []. This second LAD was long, run over the right ventricle, and gave rise to septal and diagonal branches, supplying the mid and distal territories of septal, antero-lateral wall, and apex [].