title: Dual anterior interventricular artery type IV: a rare anatomical variation.
abstract: Type IV dual anterior interventricular artery (AIVA) is a rare variant that involves bilateral connection of this vessel to the left main coronary artery and right coronary artery or right aortic sinus. We present a case of such a variant where the ectopic branch traveled an intraseptal course, i.e., through the superior aspect of the crista supraventricularis in a subendocardial position and then intramyocardially inside the upper interventricular septum to reach the anterior interventricular sulcus and descend toward the apex. In a left anterior oblique view, this course lacked the typical caudal anterior loop but it was recognized by virtue of emergence of a septal branch as the first branch of the ectopic AIVA. Recognition of this variant and differentiation among the possible courses of the ectopic branch is important for patient management.
authors.affiliation: Cardiology Department, Nicosia General Hospital, Old Road Nicosia-Limassol 213, Strovolos, P.O. Box 2029, Nicosia, Cyprus. y.andreas@yahoo.com
authors.forename: Andreas Y
authors.initials: AY
authors.lastname: Andreou
authors.forename: Panayiotis C
authors.initials: PC
authors.lastname: Avraamides
authors.forename: George M
authors.initials: GM
authors.lastname: Georgiou
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging