Anatomy, Thorax, Heart Anomalous Left Anterior Descending (LAD) Artery

Excerpt

Coronary anomalies of the left anterior descending artery (LAD) are very rare, with a frequency of less than 1% in the general population. Most patients with LAD anomalies are asymptomatic, and therefore most are discovered incidentally. However, some anomalies of the LAD put patients at risk for myocardial dysfunction, myocardial infarction, ventricular arrhythmias, and even sometimes produce a steal phenomenon. These potentially life-threatening coronary artery anomalies need to be identified and treated promptly to lower the risk of morbidity and mortality. Traditionally, the percutaneous transcatheter arteriography (PCA) was the recommended diagnostic test of choice. However, now with advancement in technology, the electrocardiographically (ECG)–gated multi-detector row computed tomography (CT) is the preferred method of diagnosis an anomalous LAD. The CT scan allows for the accurate and noninvasive depiction of coronary artery anomalies of origin, course, and termination. Treatment modalities vary by the type of LAD anomaly present. Some require surgical intervention or transcatheter intervention, while others require only medical therapy or observation. This article will describe in detail the normal structure and function of the LAD, embryologic anomalies of the LAD, surgical considerations, and clinical significance of anomalous LAD.