Anatomical variations in the left coronary artery and its branches

Mamatha H, D’Souza AS, Prasanna LC, Bhojaraja VS, Suhana S
Correspondence: Dr Mamatha Hosapatna, mamatha2010@yahoo.com

ABSTRACT
Introduction Proficiency in the anatomy of coronary arteries and their variations is important for proper interpretation of coronary angiographies. The left coronary artery (LCA) commonly originates at the level of the left posterior aortic sinus and normally bifurcates into the anterior interventricular artery and circumflex artery. This study aimed to determine the variations in the LCA and its branches.
Methods The study was conducted on 30 heart specimens. We observed the origin, length and branching pattern of the LCA and its coronary dominance.
Results We found a short main LCA trunk in three specimens and a long main LCA trunk in one specimen. In two specimens, the division of the LCA led to three branches. With regard to ‘dominance’, one specimen showed left dominance while another showed codominance.
Conclusion Variations of the LCA are clinically relevant, especially when a perioperative coronary perfusion or coronary arteriography is performed.

Keywords: angiography, coronary artery, dominance, variations, vessels
Singapore Med J 2013; 54:49-52; http://dx.dor.org/10.11622/smedj.2013012

http://smj.org.sg/sites/default/files/5401/5401a7.pdf

REFERENCE

1. Reig J, Petit M. Main trunk of the left coronary artery: anatomic study of the parameters of clinical interest. Clin Anat 2004; 17:6-13. http://dx.doi.org/10.1002/ca.10162

2. Gatzoulis MA. Heart and great vessels. In: Standring S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th ed. Philadelphia: Churchill Livingstone (Elsevier), 2008: 978-80.

3. Fiss DM. Normal coronary anatomy and anatomic variations. Appl Radiology 2007 (Suppl); 14-26.

4. McAlpine WA, ed. Heart and Coronary Arteries: An Anatomical Atlas for Clinical Diagnosis, Radiological Investigation, and Surgical Treatment. Berlin: Springer-Verlag, 1975: 133-50.

5. Vlodaver Z, ed. Coronary Heart disease: Clinical, Angiographic and Pathologic Profiles. New York: Springer-Verlag, 1976: 177-88. http://dx.doi.org/10.1007/978-1-4615-6755-4_6

6. Çandir N, Ozan H, Kocabiyik N, Ku?akligil H. Anatomical risk factors of coronary heart disease. Balkan Med J 2010; 27:248-52.

7. Kalbfleisch H, Hort W. Quantitative study on the size of coronary artery supplying areas postmortem. Am Heart J 1977; 94:183-8. http://dx.doi.org/10.1016/S0002-8703(77)80278-0

8. Angelini P, Villason S, Chan AV Jr, Diez JG. Normal and anomalous coronary arteries in humans. In: Angelini P, ed. Coronary Artery Anomalies: A Comprehensive Approach. Philadelphia: Lippincott Williams & Wilkins, 1999: 27-150.

9. Fox C, Davies MJ, Webb-Peploe MM. Length of left main coronary artery. Br Heart J 1973; 35:796-8. http://dx.doi.org/10.1136/hrt.35.8.796

10. Banchi A. Morfologia delle arteriae coronariae cordis. Arch Ital Anat Embriol 1904; 3:7-164.

11. Reig J, Jornet A, Petit M. Anatomical variations of the coronary perfusion as a basis of myocardial vulnerability to coronary artery occlusion. Clin Anat 1994; 7:315-23. http://dx.doi.org/10.1002/ca.980070603

12. Gazetopoulos N, Ioannidis PJ, Karydis C, et al. Short left coronary artery trunk as risk factor in the development of coronary atherosclerosis. Pathological study. Br Heart J 1976; 38:1160-5. http://dx.doi.org/10.1136/hrt.38.11.1160

13. Gazetopoulos N, Ioannidis PJ, Marselos A, et al. Length of main left coronary artery in relation to atherosclerosis of its branches. A coronary arteriographic study. Br Heart J 1976; 38:180-5. Banchi A. Morfologia delle arteriae coronariae cordis. Arch Ital Anat Embriol 1904; 3:7-164.

14.Green GE, Bernstein S, Reppert EH. The length of the left main coronary artery. Surgery 1967; 62:1021- 4.

15. Bosco GA. Diagnóstico anátomo-topográfico de la obstrucción arterial coronaria. Buenos Aires: Artes Gráficas Modernas, 1935: 27-30.

16. Hadziselimovi? H. Blood vessels of the human heart. Leipzig: Thieme, 1982: 14-20.

17. Benther P, Barra JA, Blanc JJ. [Descriptive anatomical study of the major coronary trunks and the principal epicardial collaterals. 125 cases]. Nouv Presse Med 1976; 5:71-5. French.

18. Datta AK. Essentials of Human Embryology. 5th ed. Kolkata: Current Books International, 2005: 71-2.