Coronary artery anomaly: Rare and anomalous branching of left coronary artery

Coronary artery anomalies are rare, but still rarer is anomalous branching pattern of the left coronary artery (LCA) alone, without any congenital anomalies. We report the case of a 50-year-old man who presented with dyspnea on exertion New York Heart Association (NYHA) class II, had a positive stress test, and his coronaryangiogram revealed the left main coronary artery (LMCA) dividing into four branches. This type of branching pattern is quite rare. He had type I dual left anterior descending (LAD) artery in addition to a fairly large ramus intermedius (RI) and a nondominant left circumflex (LCx) arising from the LCA. Awareness and recognition of dual LAD is of importance to surgeons and interventionalists alike in planning the revascularization strategy