Chairman, Department of Cardiology bei Friedrich-Alexander-University of Erlangen-Nürnberg
Dual LAD Type IV ... .. according to the frequently used classification by Spindola-Franco et al (Am Heart J 1983): The proximal LAD and diagonal branch arise from the left main coronary artery ("short LAD"), while the distal LAD territory is supplied by a separate vessel ("long LAD"), which in Type IV originates from the right coronary sinus. In the original report by Spondola-Franco, all Type IV cases had a long LAD which followed a course anterior to the pulmonary artery. Here, the course is intramyocardial/transseptal, which was later classified as "Type V" by Manchanda et al (J Cardiovasc Comput Tomogr 2010). Numerous other types have since them been added, usually minor modifications in the form of case reports. Very nice review of the four main types in Agrawal/Kazerooni, AJR 2008; 191:1698–1701
Thank you for sharing this interesting case Stephan Achenbach! 🙏 Did the course of the "long LAD" have functional significance causing ischemia in this patient? What would you consider the best way to check for it (Simple exercise stress test, FFR-CT, Stress CTP, Stress MRI, SPECT with any stressor, Stress Echo with any stressor, IVUS, OCT) ?
Brilliant image quality 👌 and thanks for sharing this rare anatomy 😳
Beautiful image!! Thanks for sharing
Grazie per questa condivisione
Thank you Prof Achenbach!
Very interesting Thanks for sharing 🙏
Very nice Stephan!
Wow beautiful case that shows the intra myocardial course
Medical Practice Professional
4wHere we go.