A case of type IV dual left anterior descending coronary artery anomaly

Dual left anterior descending (LAD) artery is a very rare congenital coronary artery anomaly. A 51-year-old woman presented with atypical chest pain and palpitation. Electrocardiography showed nonspecific ST-segment depression in inferior and lateral leads. Coronary angiography showed a rudimentary LAD artery terminating in the midportion of the anterior interventricular sulcus, after giving the first septal branch. In right coronary angiography, there was another LAD artery originating from the proximal right coronary artery and coursing to the anterior interventricular sulcus. This anomaly was consistent with type IV dual LAD.