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Classification of dual LAD

Posted in cardiology -congenital heart disease, Cardiology -Interventional -PCI, cardiology-Anatomy, tagged classification of dual LAD, coronary artery anomaly, dual Lad, Dual LAD classification, Spindola classification of dual LAD, type 6 dual lad on June 28, 2013| Leave a Comment »

Dual LAD is an interesting coronary artery anomaly proposed originaly by Spindola in 1983 .He classified it into 4 types. In recent years the dual LAD has increased from 4 to 6 types.

The essential criteria to diagnose could be summarised.

Two LADs should be identified.
One would be large and another small
Both should give a diagonal branch .

* Ramus is virtually unknown if there is dual LAD .

The origin of second LAD can be from

LMCA
RCA
Direct from Right coronary sinus

Course

Can be epicardial
Intra -myocardial
Or both

Branches

Diagonal
Septal
or Both

Drainage area

Highly variable

Implication for intervention

Apart from the surprise element , the second LAD has little impact on the interventional protocol.
However , it may confer a ischemic protection as the critical anterior wall has a twin blood supply.
Whether they are protected from primary VT or VF is to be studied because of better electrical stability
Second LAD may act as an additional collateral channel.

Spindola’s classification of Dual LAD (Types 1 to 4 was called sometimes A,B,C,D )

Source : Lee et al. BMC Cardiovascular Disorders 2012, 12 :101

Spindola type 1 to 4 classification of dual LAD

An illustration of first 4 types of Dual LAD .Note the type 4 originates from RCA. Image courtesy : Prachi P. Agarwal Ella A. Kazeroon . AJR:191, December 2008

Surgical issues ( This is excellent data from India . I convey my greetings to one the authors Dr D.B Baruah, my friend from CMC Vellore !)