DefinePK

Research Objective

To present a case of dual left anterior descending (LAD) coronary artery disease and highlight the techniques used for identifying these vessels during coronary artery bypass graft surgery.

Methodology

Case report detailing the surgical revascularization of a patient with a type-I dual LAD system, acute lesions in both LADs, and critical lesions in the right coronary artery and left circumflex coronary artery. The methodology involved on-pump coronary artery bypass graft surgery (CABG) and meticulous dissection techniques for identifying the short LAD.

Methodology Flowchart

                        graph TD;
    A["Patient Presentation with Effort Angina"] --> B["Coronary Angiography"];
    B --> C["Diagnosis: Type-I Dual LAD, Lesions in LADs, RCA, LCx"];
    C --> D["Scheduling for CABG"];
    D --> E["On Pump CABG"];
    E --> F["Identification of Short LAD via Dissection"];
    F --> G["Anastomosis of Short LAD with LIMA"];
    F --> H["Anastomosis of Long LAD, OM, Distal RCA with SVG"];
    G --> I["Post-operative Recovery"];
    H --> I;
    I --> J["Patient Discharge"];                    

Discussion

The discussion highlights the challenges in identifying dual LAD systems during CABG, particularly the intramyocardial course of the short LAD. It reviews traditional identification methods and their limitations in dual LAD cases, emphasizing the importance of understanding coronary anatomy for adequate revascularization. The "Groove sign" and "Vein sign" are discussed as clues for identifying intramyocardial LADs.

Key Findings

A 61-year-old patient with a type-I dual LAD system underwent successful CABG. The short LAD, supplying septal perforators, was identified and anastomosed with the left internal mammary artery. The long LAD, obtuse marginal artery, and distal right coronary artery were anastomosed with a saphenous vein graft. The patient recovered well.

Conclusion

Intraoperative identification of the dual LAD system is crucial for achieving complete revascularization in patients undergoing CABG with this anatomical variant.

Fact Check

1. Incidence of dual LAD: The text states that dual left anterior descending arteries are found in about 1% of the population, with reported incidence in angiographic studies ranging from 0.64-1.3%.
2. Patient's age: The patient presented was 61 years old.
3. Discharge: The patient was discharged on the fifth post-operative day.

Mind Map