Surgically revascularized dual LAD Turhan Yavuz 1 , Cem Nazlı 2 , Ahmet O ¨ cal 1 , Erdogan Ibrisim 1 & Ali Kutsal 3 1 Department of Cardiovascular Surgery, Faculty of Medicine, University of Su ¨leyman Demirel, Isparta, Turkey; 2 Department of Cardiology, Faculty of Medicine, University of Su ¨leyman Demirel, Isparta, Turkey; 3 Department of Cardiovascular Surgery, Dr. Sami Ulus Pediatric Hospital, Ankara, Turkey Received 29 April 2003; accepted in revised from 11 August 2003 Key words: coronary artery anomaly, coronary artery bypass grafting, dual LAD Abstract Dual left anterior descending artery (or dual anterior interventricular artery, LAD) is a rare coronary artery anomaly. Dual but normally originated LAD has been usually reported to have no clinical significance. In this case report, we present a case of 75 year old male with anginal symptoms in whom coronary arteri- ography showed normally originated dual LAD with two branches of almost equal caliber. The course of both branches were supplying the usual territory of LAD and both of the branches had significant proximal stenosis. The patient underwent a coronary artery bypass grafting operation and both branches were grafted. This normally originated dual LAD case may be considered to be interesting, because dual LAD branches were symmetrically involved with the atherosclerotic process in their proximal segments. In addition, this condition was demonstrated intraoperatively and the two branches were revascularized with bypass grafting. Introduction The incidence of various coronary artery anoma- lies is between 0.3 and 0.8% [1]. Most of the cor- onary anomalies are asymptomatic and course without any complication. They are usually de- tected during investigations for various clinical conditions or discovered as an incidental finding at cardiac catheterization. However, some coronary artery anomalies, especially ectopically originated anomalious coronary arteries and coronary fistu- las may cause clinical syndromes [2]. An anatomic variant of the left anterior de- scending artery (LAD) is described as ‘dual LAD’ or ‘dual anterior interventricular artery’ which consists of two branches supplying the usual dis- tribution of LAD in the left ventricle. Dual LAD is a rare coronary artery anomaly which can potentially have implications on per- cutenous coronary interventions or on surgical revascularization procedures in cases associated with coronary stenosis [3]. Case report A 75 year-old man with angina pectoris was hos- pitalized for worsening of his symptoms during the last month. The patient was decided to be evalu- ated with coronary angiography. Coronary angi- ography revealed a dual left anterior descending coronary artery (LAD) with a normal origin. Di- agonals originated from the first LAD whereas septal branches originated from the second LAD. The course of both of the branches were quite long. However the second LAD with emanating diagonal branches was longer and distally ex- tended into the posterior interventricular sulcus. The International Journal of Cardiovascular Imaging 20: 71–74, 2004. Ó 2004 Kluwer Academic Publishers. Printed in the Netherlands. 71