a rare case of a type iv dual left anterior descending artery and ectopic left anterior descending and circumflex arteries requiring surgery

Congenital anomalous coronary arteries (cacas) comprise an important variant of the coronary vasculature. they are benign in the vast majority of cases, whereas a small minority may be affected by serious consequences such as myocardial infarction, arrhythmia, cardiac arrest, and even death. we herein describe a 62-year-old man with sudden and severe substernal chest pain; q waves in electrocardiographic leads ii, iii, and avf; and positive serum troponin i enzyme. left heart cardiac catheterization revealed triple coronary vessel disease with a 60% to 70% occlusion in the left main coronary artery (lmca). the left anterior descending (lad) and the left circumflex artery arose from the ostium of the right coronary artery. additionally, a rudimentary type iv dual lad originated from the lmca. a coronary artery bypass graft surgery was performed using a left internal mammary artery graft for the lad and a saphenous vein graft for the diagonal branches (i & ii) of the lad and the posterior descending artery. the patient was discharged after an uneventful 1-week hospital course.