Clinical presentation and outcomes in type IV dual left anterior descending artery anomaly

Type IV dual left anterior descending artery (LAD) anomaly constitutes a rare subset of coronary anomalies in which the anterior and anterolateral wall of the left ventricle is supplied by a short LAD originating from the left coronary artery along with a long LAD that originates from the right sinus of Valsalva. Albeit rare, the angiographic presentation is challenging since the appearance of the short LAD is similar to a total occlusion beyond first few diagonal or septal branches. Here, we present a series of four cases with type IV dual LAD anomaly with different clinical and angiographic presentations.