Coexisting Dual Left Anterior Descending Coronary Artery and Double Right Coronary Artery in a Single Patient Undergoing Coronary Artery Bypass Graft Surgery

Coronary artery anomalies are uncommon and are most frequently identified incidentally during coronary angiography. Among these, the presence of a dual left anterior descending artery is relatively frequent, with an incidence of around 1%, whereas a double right coronary artery is uncommon. We describe the case of a 63-year-old male who presented with Class III angina. Coronary angiography revealed complex multivessel coronary artery disease with dual left anterior descending artery (Type A.2.1.2) and double right coronary artery (Type G2). The patient underwent coronary artery bypass grafting performed with the aid of cardiopulmonary bypass. Complete myocardial revascularization was performed by anastomosing the left internal mammary artery to the septal left anterior descending artery, along with reversed saphenous vein grafts to obtuse marginal branches 1 and 2, and the second right coronary artery. This case underscores the simultaneous presence of two rare coronary anomalies in a single patient undergoing surgical coronary revascularization. To the best of our knowledge, this may be the first reported case to undergo surgical revascularization. Recognition of such variants is essential to ensure complete revascularization and prevent postoperative ischemia.