case_images: PMC11830952_01
case_images: (A) Left anterior oblique cranial view shows a short left anterior descending artery with small septal branches and diagonal arising from the same. The left circumflex is normal. (B) Left anterior oblique cranial view showing a long left anterior descending artery is seen arising from the proximal right coronary artery, as it traverses across towards the anterior interventricular sulcus. A diagonal branch arising from long left anterior descending artery is also seen and septal branches. (C) Left anterior oblique caudal view showing a proximal right coronary artery lesion, located just beyond the origin of the long left anterior descending artery. (D) Left anterior oblique caudal view displaying a proximal right coronary artery lesion, located just beyond the origin of the extended left anterior descending artery. (E) Right anterior oblique caudal view showing long course of proximal part of long left anterior descending artery as it traverses across towards the anterior interventricular sulcus. A diagonal branch arising from long left anterior descending artery is also seen. (F) Right anterior oblique cranial shows a short left anterior descending artery with small septal branches and diagonal arising from the same. S-LAD: short Left anterior descending artery; L-LAD: long Left anterior descending artery; S: septal branches; D: diagonal branches; RCA: right coronary artery; LCX: left circumflex.
case_images: ytaf032f1.jpg
case_images: PMC11830952_01_ytaf032f1.jpg
case_images: ytaf032-F1
case_images: Serial ECGs demonstrated a reduction in ST-segment elevation by >50% within 30 min and almost complete resolution within 90 min ([Supplementary material online, Figure 1 will include serial ECGs, providing a chronological representation of the patient's electrocardiographic changes]). Distal to the common ostium, there was a significant stenosis of RCA (90%-95%), proximal right posterior descending artery (RPDA) of 70%-80%, and proximal obtuse marginal 1 artery of the left circumflex artery (30%-50%) (Figure 1, [Supplementary material online, Figure 2 will include all videos (2-1.avi, 2-2.avi, 2-3.avi, and 2-4.avi), documenting key procedural and clinical findings.]) Percutaneous coronary intervention (PCI) was performed on the RCA.
case_images: (A, B) Volume rendering computed tomography coronary image shows a type 4 dual left anterior descending artery. The short left anterior descending artery gives off the first major diagonal branch and ends in the proximal anterior interventricular groove. The aberrant long left anterior descending artery origin from the right coronary artery ostium is seen taking a pre-pulmonic course and enters the mid-anterior interventricular groove. LMCA: left main coronary artery; LAD1: short Left anterior descending artery; LAD2: Long left anterior descending artery; RCA: right coronary artery; LCX: left circumflex.
case_images: ytaf032f2.jpg
case_images: PMC11830952_01_ytaf032f2.jpg
case_images: ytaf032-F2
case_images: Distal to the common ostium, there was a significant stenosis of RCA (90%-95%), proximal right posterior descending artery (RPDA) of 70%-80%, and proximal obtuse marginal 1 artery of the left circumflex artery (30%-50%) (Figure 1, [Supplementary material online, Figure 2 will include all videos (2-1.avi, 2-2.avi, 2-3.avi, and 2-4.avi), documenting key procedural and clinical findings.]) Percutaneous coronary intervention (PCI) was performed on the RCA. The long LAD gives rise to the rest of the diagonal and perforator arteries (Figure 2).