Project description:We report a rare coronary artery anomaly-anomalous origin of the left anterior descending artery from the pulmonary artery in a 40-year-old woman. The uniqueness of this case is the absence of any significant morbidity from this condition in adulthood which is in contrast to other reported cases where patients present with myocardial infarction, congestive heart failure, and sometimes death during the early infantile period.(1).
Project description:Dual left anterior descending artery (LAD) is a rare congenital coronary artery anomaly with a prevalence of approximately 1% in the general population. To date, 10 types of dual LAD artery anomalies have been reported. Among these, type 4 is one of the rarest. Knowledge and recognition of the dual LAD artery are important for correct diagnosis and planning of coronary bypass surgery and percutaneous coronary intervention. We report a case of a 59-year-old male with type 4 dual LAD artery who presented with dyspepsia and sweating for several months and had approximately 50%-70% stenosis in a major diagonal branch off the short LAD artery.
Project description:BackgroundCoronary artery aneurysms (CAAs) are rare, and giant CAAs are even rarer. The pathophysiology of this phenomenon is still unknown.Case presentationHerein, we present the case of a 49-year-old male with a giant aneurysm in the left anterior descending artery.ConclusionsThe optimal treatment for CAAs is debatable, but surgical intervention is preferred for giant CAAs.
Project description:Coronary bifurcation angles influence plaque initiation in the coronary artery, and changes in blood flow caused by tortuosity in the coronary arteries can reduce blood pressure distal to the tortuous portion of the coronary artery, leading to myocardial ischemia. We aimed to describe two factors (coronary artery tortuosity and bifurcation angle) as one descriptor for the evaluation of proximal left anterior descending coronary artery (LAD) disease. We reviewed the medical records of 133 consecutive patients who underwent computed tomography angiography (CTA) for angina symptoms between November 2019 and January 2020. The patients were divided into two groups according to the presence of significant LAD stenosis on CTA (defined as LAD stenosis >50%). The straight length of the vessel was measured using the central luminal line of the flow path, and, calculated using proprietary algorithms in TeraRecon software. We used three-dimensional volume rendering and two-dimensional axial images to measure the left main coronary artery (LM)-LAD angles. In the univariate analysis, there were significant differences in the linear distance between the endpoints of the 20 mm actual curve of the LAD (d20), cosine value for LM-LAD angle (cosθ) <0.8, age, presence of hypertension or diabetes, and number of pack years [hazard ratio (HR): 2.70, 8.04, 1.05, 3.70, 2.82, and 1.04; P=0.029, P<0.001, P=0.020, P=0.024, P=0.021, and P=0.002, respectively]. However, in the multivariate analysis, the cosθ multiplied by d20 (d20*cosθ) <15.5, presence of hypertension and number of pack years (HR: 11.36, 4.54, and 1.04; P<0.001, P=0.019, and P=0.003, respectively) were predictors of significant proximal LAD stenosis. As the tortuosity and LM-LAD angle increased (d20 and cosθ decreased, respectively), the chance of proximal LAD lesions formation increased. d20*cosθ might be useful as a predictor of proximal LAD stenosis.
Project description:BackgroundSingle coronary artery (SCA) is a rare congenital coronary anomaly with incidence of 8-66 per 100 000 cases. Percutaneous coronary intervention (PCI) in patients with SCA is technically challenging. This is a case of bifurcation angioplasty involving left anterior descending/right coronary artery (LAD/RCA) in a patient with SCA and 1-year follow-up with computed tomography coronary angiography (CTCA).Case summaryA 52-year-old female with history of PCI to LAD 4 months back, presented with non-ST-elevation myocardial infarction. Coronary angiogram showed 90% stenosis in mid-LAD, distal to the previous stent and proximal to an anomalously originating RCA from mid-LAD. She was planned for LAD/RCA provisional bifurcation angioplasty and a drug-eluting stent was deployed in LAD across RCA, following which patient developed angina with ischaemic electrocardiogram (ECG) changes due to significant pinching of RCA. Using Reverse crush technique, RCA was stented successfully with resolution of angina and ECG changes. At 1-year follow-up, patient is in New York Heart Association class I with normal left ventricular function and patent LAD/RCA bifurcation stent on CTCA.DiscussionSCA poses a great challenge to interventional cardiologists during PCI, especially in the event of a complication. Detailed anatomical knowledge, appropriate hardware and operator expertise are the key factors for successful PCI of SCA. This is, to the best of our knowledge, the first case report of bifurcation angioplasty of LAD/RCA in a rare case of SCA. This case also describes the use of reverse crush technique as a bailout strategy during provisional bifurcation angioplasty.
Project description:A novel coronary anatomy in the form of anomalous left anterior descending coronary artery from pulmonary artery with a retroaortic left circumflex arising from the right coronary artery is presented. This unreported anatomy was discovered in a 7-month-old girl with failure to thrive. (Level of Difficulty: Intermediate.).
Project description:Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is divided into six subgroups in the literature according to the origin and course of the short and long branches of the anomalous artery. We present two distinct cases of dual LAD which are distinguished by two branches of equal length from their counterparts in the literature. <Learning objective: In our cases a novel dual LAD variant is presented with two main branches of equal length and reaches the cardiac apex. Cardiologists and cardiovascular surgeons should be aware of these variants to avoid misinterpretation of coronary angiography and intraoperative complications.>.
Project description:Coronary artery fistulas (CAFs) are rare coronary anomalies involving the communication of an epicardial coronary artery and another cardiovascular structure. CAFs are usually easily distinguished from nearby coronary arteries. Here, we report a unique case of CAF that mimics the size, branching pattern, and appearance of a native epicardial left anterior descending artery.