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Variant of the left coronary artery with an unusual origin and course: anatomic and postmortem angiographic findings
C E Nerantzis1, P N Koutsaftis
1Forensic Medical Service of Athens, Greece.
Insights
This study details a rare coronary artery anomaly where the left coronary (LC) artery originates with the right coronary (RC) artery from the right aortic sinus. Its unique course through the ventricular septum is visualized via angiography.
Area of Science:
- Cardiovascular Anatomy
- Interventional Cardiology
- Radiological Imaging
Background:
- Congenital coronary artery anomalies are significant in cardiovascular diagnosis.
- Understanding anomalous coronary artery origins and courses is crucial for accurate interpretation of cardiac imaging.
- A rare anomaly involves the common origin of both coronary arteries from the right aortic sinus.
Purpose of the Study:
- To describe the detailed anatomical course of a rare anomalous left coronary artery (LC) originating from the right aortic sinus.
- To correlate postmortem angiographic and corrosion casting findings with radiological appearance.
- To aid in the interpretation of coronary angiographies in patients with this specific anomaly.
Main Methods:
- Analysis of anatomic and postmortem angiographic findings.
- Examination of 60 corrosion castings.
- Review of 388 coronary angiographies identifying a single case of this anomaly.
Main Results:
- The left coronary (LC) artery originated in common with the right coronary (RC) artery from the right aortic sinus.
- The LC artery coursed through the ventricular septum (VS) to the left heart.
- The LC artery's course was divided into four segments, with specific descriptions of its shape in anteroposterior and right anterior oblique views, resembling a '6'.
Conclusions:
- This rare coronary artery anomaly, with a common origin and septal course, requires careful identification.
- Detailed knowledge of this anomaly's course is essential for accurate interpretation of coronary angiograms.
- The described anatomical features provide a basis for understanding the imaging characteristics of this condition.
Abstract:
This study demonstrates anatomic and postmortem angiographic findings characterizing the origin of the left coronary (LC) artery arising in common trunk with the right coronary (RC) artery from the right aortic sinus and its course via the ventricular septum (VS) to the left heart. This anomaly was a single finding observed among 388 angiographies and 60 corrosion castings. The course of the LC was divided in four segments. The first three form a curve that is upward concave. Large branches to the septomarginal trabecula (ST), VS, diagonals (DS), and the small anterior interventricular (anterior descending) artery originated from the outer part of this curve. In the anteroposterior x-ray, the above curve resembles a deep-bottom pot with a handle corresponding to the fourth segment. In the right anterior oblique, the first and second segments form a large erect angle. The third segment occupies the lower part of the absent proximal anterior interventricular artery, and the fourth crosses the outflow tract and the first segment in the middle. The course of these four segments of LC resembles the shape of the number 6. These findings are important for interpreting coronary angiographies in patients with this anomaly.