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A clinically useful coding system for normal coronary artery anatomy
Insights
This study analyzed coronary arteriograms to map normal coronary artery anatomy and identify graftable vessels. A classification system was developed to aid in comparing and interpreting coronary artery anatomy for surgical planning.
Area of Science:
- Cardiovascular Anatomy
- Interventional Cardiology
- Surgical Planning
Background:
- Normal coronary artery anatomy is crucial for surgical planning.
- Identifying potentially graftable vessels requires precise anatomical understanding.
- Existing classification methods may lack sufficient detail for comparative analysis.
Purpose of the Study:
- To describe normal coronary artery anatomy and the distribution of potentially graftable vessels.
- To develop a simple classification system for coronary artery origins.
- To facilitate accurate comparison in published series and assist coronary arteriographers.
Main Methods:
- Review of cine coronary arteriograms from 121 patients with normal coronary arteries.
- Categorization of arteriograms into right, mixed, and left interior emphasis systems based on left ventricular inferior surface blood supply.
- Development of a lettering and numbering code to describe coronary artery origins relative to the left anterior descending (LAD) coronary artery.
Main Results:
- The diameter of the LAD at its origin averaged 4.2 mm.
- Vessels greater than 70% of the LAD diameter were considered graftable.
- Frequency of graftable vessels varied by system: Right Coronary Artery (100%, 100%, 0%), LAD (100%, 100%, 100%), Intermediate Artery (8.7%, 12.5%, 33.3%), Obtuse Marginal Artery (53.7%, 43.7%, 44.4%), Atrioventricular Groove Artery (0%, 56.2%, 100%), Diagonal Branch of LAD (15%, 6.3%, 11.1%).
Conclusions:
- A simple classification method for coronary artery anatomy can improve comparative analysis.
- This system aids coronary arteriographers in interpreting findings.
- Accurate anatomical description is vital for identifying graftable vessels in coronary artery bypass grafting.
Abstract:
Cine coronary arteriograms of 121 patients with normal coronary arteriograms with and without associated valvular or myocardial disease were reviewed to describe normal coronary artery anatomy and the distribution of potentially graftable vessels. Coronary arterio grams were divided into right, mixed, and left interior emphasis systems, depending upon the blood supply to the inferior surface of the left ventricle. Whether a coronary artery at its origin was less than 50%, between 50-70% of the left anterior descending coronary artery (LAD) at its origin was described in a simple lettering and numbering code to allow easy comparison. The diameter of the LAD at its origin averaged 4.2 mm. All vessels greater than 70% of the LAD were clearly graftable. The frequency (in percent) with which that vessel was greater than 70% of the LAD in right, mixed, and left systems, respectively, was as follows: right coronary artery 100. 100. 0. LAD 100. 100. 100. intermediate artery 8.7 12.5 33.3 obtuse marginal artery 53.7 43.7 44.4 atrioventricular groove artery 0. 56.2 100. diagonal branch of the LAD 15. 6.3 11.1. This simple method of classification is recommended to provide more accurate comparison in published series and to assist the coronary arteriographer in his interpretations.