CTICasesType A Aortic Dissection Spared by Anomalous Separate Origins of the Left Anterior Descending and Left Circumflex Arteries
Imaging findings
Computed tomography (CT) demonstrates a dilated aortic root and ascending aorta with an acute Type A aortic dissection. The dissection flap extends directly into the ostium of the anomalous left anterior descending (LAD) coronary artery, completely obstructing its flow. However, the left circumflex (LCx) artery is entirely spared due to a rare congenital coronary variant in which the LAD and LCx arise from separate ostia in the left coronary sinus, meaning there is no true left main coronary artery. ECG-gated cardiac imaging or echocardiography reveals severe hypoattenuation and akinesis of the myocardium in the LAD distribution (anterior wall, septum, and apex), while the inferior wall supplied by the right coronary artery remains well perfused.
Key takeaways
Anomalous separate origins of the LAD and LCx from the left sinus of Valsalva is a congenital coronary variant seen in up to 2% of patients in historical catheterization literature, though it is encountered less frequently on coronary CT angiograms. While coronary ostial involvement is a catastrophic and often fatal complication of Type A aortic dissection, this specific anatomical variant can be life-saving by isolating the coronary ischemia to a single territory (the LAD) and sparing the LCx distribution from occlusion.
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