Congenital anomalous coronary arteries (CACAs) comprise an important variant of the coronary vasculature. They are benign in the vast majority of cases, whereas a small minority may be affected by serious consequences such as myocardial infarction, arrhythmia, cardiac arrest, and even death. We herein describe a 62-year-old man with sudden and severe substernal chest pain,Q waves in electrocardiographic leads II, III, and aVF,and positive serum troponin I enzyme. LEFT heart cardiac catheterization revealed triple coronary vessel disease with a 60% to 70% occlusion in the LEFT main coronary artery (LMCA). The LEFT ANTERIOR DESCENDING (LAD) and the LEFT circumflex artery arose from the ostium of the right coronary artery. Additionally, a rudimentary type IV dual LAD originated from the LMCA. A coronary artery bypass graft surgery was performed using a LEFT internal mammary artery graft for the LAD and a saphenous vein graft for the diagonal branches (I & II) of the LAD and the posterior DESCENDING artery. The patient was discharged after an uneventful 1-week hospital course.

Introduction: Limited information is available regarding the relationship between coronary vessel dominance and atherosclerotic involvement. Rheological factors have been implicated in the pathogenesis of coronary lesions. More than 90% of the coronary blood flow enters the LEFT coronary if it is the dominant artery. The main purpose of this study was to determine the relation between LEFT coronary dominance and atherosclerotic involvement of LEFT ANTERIOR DESCENDING artery (LAD) origin. In addition, the prevalence and degree of associated ischemic mitral regurgitation (MR) in these patients were assessed.Methods: The study included 678 consecutive patients with an indication for coronary angiography. One hundred and twenty two patients with right dominant and 61 patients with LEFT dominant arteries were randomly selected for analysis. All demographics, risk factors, coronary dominancy and involvement, LEFT ventricular ejection fraction (LVEF), and MR were recorded.Results: One hundred and eighty three patients (mean age of 57.7 years) were studied. The types of coronary circulation included right, LEFT, and balanced in 78.6%, 8.9%, and 12.5%, of the patients respectively. In 64 patient with significant LAD lesions, 22 (34.9%) had ostial while the remainder had non-ostial involvement. Ischemic MR was present in 5 (2.7%) patients. There was no difference in demographics, risk factors, LVEF, MR, extent of coronary artery disease, and LAD ostial involvement between LEFT and right dominant circulations.Conclusion: In this study, LEFT coronary dominance was not associated with atherosclerotic involvement of LAD ostium and ischemic MR.

Congenital coronary artery anomalies are relatively rare, occurring in approximately 0. 6%-1. 3% of cases undergoing coronary angiography. Among these anomalies, a unique cardiac abnormality known as a dual LEFT ANTERIOR DESCENDING artery (LAD) stands out. A dual LAD is characterized by the presence of 2 LADs in the ANTERIOR interventricular sulcus. This structural deviation consists of a shorter LAD that terminates high in the ANTERIOR interventricular sulcus and a longer LAD that extends to the distal sulcus, supplying blood to the cardiac apex. Percutaneous procedures on dual LADs are even less frequent. We describe a 53-year-old woman with typical burning chest pain, ST-elevation in leads I and aVL, and positive troponin I enzyme. Coronary angiography revealed a thrombotic lesion with 99% stenosis at the proximal part of the LAD. The main LAD originated properly from the LEFT coronary cusp, and the remainder of its course was supplied by a second branch originating from the right coronary cusp. Computed tomography angiography and echocardiography were performed for the LAD course. The patient was discharged after an uneventful 1-week hospital stay. Our case is particularly noteworthy for several reasons. Firstly, this dual LAD anomaly is uncommon, and patients with dual LADs less frequently have a ramus artery. Secondly, there have been only a few documented cases of percutaneous transluminal coronary angioplasty performed on short LADs. The key takeaway from this scintillating case study is the significance of identifying the artery responsible for blood supply to the cardiac apex.

Coronary artery dissection is a well-known albeit unusual complication of blunt chest trauma. It is also an uncommon cause of myocardial infarction. Only a few such cases have been reported, probably due to the high rate of sudden death. We report a case of LEFT ANTERIOR DESCENDING (LAD) coronary artery dissection in a healthy 38-year-old female caused by blunt chest trauma. The patient was referred to our hospital with a complaint of chest pain. Electrocardiography showed T-wave inversion, echocardiography a revealed circumferential pericardial effusion, and the coronary angiogram demonstrated a thrombotic dissection of the LAD.  Troponin I was the only biomarker with elevated level. CT coronary angiography was performed using the subtotal occlusion of the LAD and illustrated a relatively good LAD run-off, and thallium scintigraphy displayed viable myocardium in this territory. Despite the total occlusion of the LAD in our case, myocardial injury was not significant due to the relatively good LAD run-off. She underwent coronary artery bypass graft surgery with an excellent result.

Traumatic coronary artery-cameral fistulas (TCAF) are rare and may present secondary to penetrating injuries (80%) or iatrogenic traumas. Early operative intervention remains the recommended treatment modality for accidental traumatic coronary artery fistulas. We report the case of a 17-year-old man who presented with LEFT ANTERIOR DESCENDING coronary artery-right ventricle fistula following penetrating cardiac trauma, which was successfully repaired surgically.

62 years–old woman with chief complaint of repeated compressive chest pain on physical activity presented to the emergency department. Angiography showed narrowing of mid part of LEFT ANTERIOR DESCENDING artery at systole, normal caliber in diastole and good distal flow but after normalization of blood pressure and pulse rate, the LEFT ANTERIOR DESCENDING artery lesion disappeared in systole and diastole. As in this patient, it is imperative to note that hypotension due to any cause such as vasovagal reaction, could stimulate myocardial bridge.