Amamoto Soujiro, Yoshikai Masaru, Miho Takahiro, Koga Kiyokazu
Department of Cardiovascular Surgery, Shin-Koga Hospital, Fukuoka, Japan.
Kyobu Geka. 2017 Mar;70(3):207-210.
A 77-year-old male presented with angina pectoris. On coronary angiography, the left anterior descending artery(LAD) was obstructed after branching the second septal branch. Three-dimensional (3D) images constructed with 64-slice computed tomography (CT) showed type I dual LAD. The short LAD, which had been erroneously recognized as a septal branch on coronary angiography, ran on the anterior interventricular sulcus (AIVS) where it then terminated. The long LAD, which was obstructed at its origin, ran on the left ventricular side of the AIVS, and entered the distal part of the AIVS. Coronary artery bypass grafting including a bypass to the long LAD was successfully performed. Recognition of the dual LAD, a rare coronary artery anomaly regarding its origin and course, is import ant in performing successful myocardial revascularization procedures. The 3D-CT images are extremely useful in demonstrating dual LAD, especially in cases where there is occlusion of the LAD.
一名77岁男性因心绞痛就诊。冠状动脉造影显示，左前降支（LAD）在发出第二间隔支后受阻。64层计算机断层扫描（CT）构建的三维（3D）图像显示为I型双LAD。短LAD在冠状动脉造影时被错误地识别为间隔支，走行于前室间沟（AIVS）并在该处终止。长LAD在其起始处受阻，走行于AIVS的左心室侧，并进入AIVS的远端。成功实施了包括对长LAD进行搭桥的冠状动脉旁路移植术。认识双LAD这种在起源和走行方面罕见的冠状动脉异常，对于成功实施心肌血运重建手术很重要。3D-CT图像在显示双LAD方面极其有用，尤其是在LAD闭塞的病例中。
