Clinical Importance of left coronary artery and its variation

Rubi Bhola, Gunjan Rai and Royana Singh

Department of Anatomy,
Institute of Medical Sciences,
Banaras Hindu University,
Varanasi-221005
Introduction
Arterial supply to heart is achieved by two
arteries which are the only branches from
ascending aorta.

These arteries branch in such a manner

that they occupy atrioventricular and
interventricular groove in the shape of a
crown. Hence they are called the coronary
arteries.
Coronary arteries are the first branches of
aorta which supplies blood to myocardium.

Coronary arteries, normally found in pairs,

may vary in origin, distribution, number
and diameter.
According to the World Health
Organization (WHO), coronary heart
diseases is the main cause of death in the
industrial world.

Risk factors –
lipid disorders
hypertension
diabetes
obesity
lack of physical activities
Why is left coronary
artery clinically
important ???
It supplies a greater volume of
myocardium, including almost all the left
ventricle and atrium.

When coronary artery anomalies are

encountered during coronary artery
surgeries, even minor variations may lead
to considerably increased morbidity.
It is essential to have prior knowledge not
only of the normal origin, course and
distribution of the left coronary artery but
also of its possible variations, common as
well as rare.
Material And Method
Patients were collected from following
departments of SSH,BHU:

1. Forensic Medicine
2. Cadavers from Department of Anatomy
3. CT scan from Department of Radiology.
4. Conventional Angiography from
Department of Cardiology.
35 hearts collected from cadavers from

anatomy department & unclaimed dead

body from the forensic department and 70
CT angiogram and 26 conventional
angiogram from the Department of
radiology and department of cardiology
respectively were taken.
Discussion

In present study the left coronary ostia

were present at the left posterior aortic
sinus in all the specimens studied .

There were no variations in the position of

the ostia.
 Method Bifurcation Trifurcation Tetrafurc Pentafurcati
used into LAD ation on
and LCx
arteries

Present Dissection 51.42% 34.28% 11.42% 2.85%

study

Ballesteros Injecting 52% 42.2% 5.8%

and with
Ramirez, synthetic
2008 resins

Lujinovic et Dissection 65% 35%

al. 2005

Lujinovic et Angiography 71% 29%

al. 2005

Reig and Dissection 62% 38%

Petit, 2004
Result
 Branching pattern of L 80

70

60

50

40

30

20

10

0
Single Bifurcation Trifurcation Quardrification Pentafurcation

Bar diagram representing comparison of anatomical and

radiological study for branching pattern of left coronary
artery.
Dissected heart showing bifurcation of Left main coronary artery
into Left anterior descending artery (LAD) and Left circumflex
artery (LCx), Left anterior descending artery with SA nodal artery.
Photograph of dissected heart showing trifurcation of Left main
coronary artery (LMCA) into Left anterior interventricular artery
(LAD),Left circumflex artery( LCx) and ramus intermedius(median
artery) arteries
Photograph of dissected heart showing tetrafurcation of Left main
coronary artery (LMCA) into Left anterior interventricular
artery( LAD), Left circumflex artery(LCx) and two diagonal artery
arising directly from Left coronary artery
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THANK YOU
Clinical Importance
The left coronary artery and its branches are responsible
for the irrigation of most of the left ventricle and part of
the right ventricle. In case of trifurcation, where the left
diagonal artery takes origin directly from the left coronary
artery, the size of infarct on occlusion of the left anterior
descending artery would be reduced. The left circumflex
artery taking origin from the right sinus of Valsalva is an
anomaly which may remain clinically silent, but at times it
has been known to get compressed during valve
replacement surgery, if not detected preoperatively. In
hearts where both SA and AV nodal arteries originated
from left coronary artery (8%), occlusion of the left
coronary a could severely affect the conducting system.
 A steady decrease in arterial cross-sectional
area can eventually lead to complete blockage of
the artery. As a result, oxygen and nutrient
supply to the myocardium decreases below the
level of demand. As the disease progresses, the
myocardium downstream from the occluded
artery becomes ischemic. Myocardial ischemia
not only impairs the electrical and mechanical
function of the heart, but also commonly results
in intense, debilitating chest pain known as
"angina pectoris." Eventually, myocardial
infarction may occur if the coronary artery
disease is not detected and treated in a timely
manner, leading to heart failure and/or sudden
cardiac death.