Novel variant of dual left anterior descending artery arising from single right coronary artery anomaly presenting with angina inversa

Case report

A 55-year-old female without a history of coronary artery disease, hypertensive for 17 years duration was admitted with chest pain at rest. Her electrocardiography revealed negative T-wave in anterior chest leads (Fig. 1), and T waves were returned to normal fashion without medical treatment within 10 minutes (Fig. 2). Echocardiogram showed normal left ventricle systolic function and ejection fraction (> 60%). Her biochemical parameters were within normal limits and her stress test was normal as well. She was subjected to coronary angiography to rule out any ischaemic aetiology. At coronary angiography, there was no obstructive coronary artery disease; however, the coronary angiogram demonstrated an anomalous coronary anatomy, with the origin of the right coronary artery and left main stem from the right sinus of Valsalva as a common coronary trunk (single coronary artery) (Fig. 3). Circumflex and left anterior descending arteries were arising from the left main stem. Right coronary artery was normal. Meanwhile, a second left anterior descending artery was seen arising from the proximal right coronary artery (Fig. 3 and 4). This was consistent with the novel variant of dual left anterior descending artery maybe subgroup of type IV according to Spinaldo-Franco Classification [1]. It emphasises that T wave abnormalities and chest angina may be related this congenital coronary anomaly.

Reference

1. Spinaldo-Franco H, Grose R, Solomon N. Dual left anterior descending artery: angiographic description of important variants and surgical implications. Am Heart J 1983; 105: 445-448.