CARAT Case Studies: Coronary Artery Variants and Anomalies (CAVA)

Case Study A02-6: LCA from RC Sinus - Course Low between PA and Ao. dLAD separately supplied from RCA BUT follows unusual septal course before surfacing in mid anterior IV groove.

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LCA_RAO 2 Cran 44
he first 1/3 of the anomalous LAD passes through the septum before returning to the surface in the IV groove. Note occluded D1.

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LCA_RAO 30 Caud 19
Abnormal ‘rectangular’ dLAD septal pathway well seen.

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LCA_RAO 39 Cran 40
Small perforators originate from the intra-septal portion of the anomalous dLAD.

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RCA_LAO 33 Cran 22
Dominant RCA.

Anatomy – This is a unique instance of an anomalous LCA from the RC Sinus that courses low between Ao and PA with a separate dLAD connection with the RC Sinus. The unique feature is the ‘septal’ pathway followed by the anomalous distal LAD through the septum before emerging to the surface in the IV groove. Anomalous distal LAD instances usually pass anterior to the PA.

Construction – (Select Settings > Choose Button Q Nums.) Template buttons Q1.4.2 and Q3.1.A.8 set the stage for is anomaly; the inter-septal LAD pathway is achieved by ‘right-clicking’ on the anomalous LAD and selecting the ‘anomalous septal dLAD’ option.

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