- LAD aka widow maker
- Branch of the Left Main
- diameter 4-5mm
- length varies
- type-I – does not supply the left ventricular (LV) apex,
- type-2 – supplies part of the apex, the rest being supplied by the right coronary both,
- type3 – supplies the entire apex, and
- type-4 – supplies the apex and >25% of the inferior wall (wrap around).
- 50% circulation of the heart
- Epicardial surface
- Sometimes a portion is intramuscular aka myocardial bridging
- Lymphatics of the heart travel with the Arteries
- Septal branches supplying 2/3 of the septum
- Diagonals – supplying the anterior free wall of the LV
- Arc of vieussens Conal
- Anterolateral papillary muscle of RV
- Absent Left MAin
- Coronary Fistulae: Coronary fistulae are rare in adults, but account for 50% of pediatric coronary anomalies. A fistula between a coronary artery and the cardiac cavity is called a coronary-chimeral fistula, that between a coronary artery and vein is called an arterio-venous fistula. Most fistulae are congenital. Acquired ones are usually iatrogenic or traumatic.
- Anomalous Origin: Anomalous origin of left coronary artery from the pulmonary artery is a rare malformation (incidence of 0.25–0.50%) in children with abnormal cardiac development leading to a mortality rate of 90% in unoperated infants.
Left anterior descending: (coronary artery of Vieussens) The LAD courses in the anterior interventricular groove towards the apex of the heart . a direct continuation of the LM stem from the bifurcation nourishes the anterior and lateral wall of the left ventricle by coursing anteriorly and inferiorly towards the apex.
Course : The LAD a direct continuation of the LM from the bifurcation, adopts a S shaped course by passing to the left of the pulmonary trunk and then running anteriorly and inferiorly in the anterior interventricular groove towards the apex which it wraps around in as many as 80% of the cases to reach the inferior wall. It occasionally continues through the posterior interventricular groove, where it is known as Mouchet’s posterior recurrent interventricular artery. The left anterior descending artery (LAD) has the most constant origin, course and distribution and is usually divided into proximal, middle and distal segments.
Branches of LAD: The LAD gives rise to two main groups of branches. (1) The septal branches, which supply the anterior two-thirds of the septum, and (2) The diagonal branches, which lie on the lateral aspect of the left ventricle. A third set of branches are the right free wall branches.
References and Links
Ibraheem Rehman; Afzal Rehman. Anatomy, Thorax, Heart Left Anterior Descending (LAD) Artery Stat Pearls