Anatomical variations in coronary artery origin, branching pattern, dominance, and morphometry: a cadaveric study from Northeast India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262371Keywords:
Coronary arteries, Coronary artery anomalies, Coronary dominance, Cadaver, Left coronary arteryAbstract
Background: The coronary arteries exhibited significant anatomical variability in its origin, branching pattern, and dominance. Accurate knowledge of these variations is essential for the interpretation of coronary angiography and the planning of percutaneous coronary intervention, coronary artery bypass grafting, and aortic root surgeries. Cadaveric studies provide detailed anatomical information that is invaluable for clinical practice.
Methods: A descriptive cross-sectional study was conducted on 30 formalin-fixed adult human cadaveric hearts in the Department of Anatomy, Regional Institute of Medical Sciences, Imphal, from July 2025 to March 2026 after Institutional Ethics Committee approval. Coronary arteries were dissected to evaluate the position of the coronary ostia relative to the sinotubular junction, branching pattern, coronary dominance, myocardial bridging, and anomalies. The length of the left coronary artery (LCA) trunk was measured using a digital Vernier caliper, and data were analyzed using IBM statistical package for the social sciences (SPSS) statistics version 26.
Results: The LCA ostium was located below the sinotubular junction in 86.7% of hearts, while the right coronary artery (RCA) ostium was below the junction in 80.0%. The LCA exhibited bifurcation in 60.0%, trifurcation in 26.7%, and tetra- and pentafurcation in 6.7% each. The sinoatrial nodal, conus, posterior interventricular, and right marginal arteries arose from the RCA in 96.7%, 86.7%, 90.0%, and 30.0% of specimens, respectively. Myocardial bridging was present in 20.0%, and a third coronary artery in 3.3%. The mean LCA trunk length was 9.34±3.39 mm. Right coronary dominance was observed in 86.7% of hearts.
Conclusions: Coronary arteries exhibited significant anatomical variability, particularly in the location of the coronary ostia and branching pattern of the LCA. These findings provide clinically relevant anatomical data that may improve the safety and accuracy of coronary imaging and surgical and interventional procedures.
References
Standring S, editor. Gray's anatomy: the anatomical basis of clinical practice. 41st ed. New York: Elsevier; 2016:1016-20.
Ravi V, Tejesh S. Anatomical variation in branching pattern and dominance in coronary arteries: a cadaveric study. Int J Anat Res. 2017;5(4):3611-7.
Garg A, Ogilvie BC, McLeod AA. Anomalous origin of the left coronary artery from the non-coronary sinus of Valsalva. Heart. 2000;84:136.
Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990;21:28-40.
Marik D, Gately HL, Strauss R, Starr A. Anomalous origin of the right coronary artery from the pulmonary artery. J Card Surg. 1995;10:55-8.
Garg N, Tiwari A. Primary congenital anomalies of the coronary arteries: a coronary arteriographic study. Int J Cardiol. 2000;74:39-46.
Von Lüdinghausen M. Anatomical variations of coronary vessels: influence of ethnic and geographic factors. Clin Anat. 2007;20(3):150-60.
Baptista CA, DiDio LJA, Prates JC. Types of division of the left coronary artery and the ramus diagonalis of the human heart. Jpn Heart J. 1991;32(3):323-35.
Manju M, Kaur D, Nair N. Morphology and morphometry of coronary ostia in adult human cadaveric hearts. J Anat Soc India. 2007;56:115.
Bhimalli S, Dikshit D, Siddibhavi M, Shirol VS. A study of variations in the coronary arterial system in cadaveric human hearts. World J Sci Technol. 2011;1(5):30-5.
Kalpana RA. A study on principal branches of coronary arteries in humans. J Anat Soc India. 2003;52(2):137-40.
Loukas M, Groat C, Khangura R, Owens DG, Anderson RH. The normal and abnormal anatomy of the coronary arteries. Clin Anat. 2009;22(1):114-28.
Ballesteros LE, Ramirez LM. Morphological expression of the left coronary artery: a direct anatomical study. Folia Morphol (Warsz). 2008;67(2):135-42.
Joshi SD, Joshi SS, Athavale SA. Origins of the coronary arteries and their significance. Clinics (Sao Paulo). 2010;65(1):79-84.
Dharmendra P, Takkapalli A, Madan S, Londhe P. Clinically significant anatomical variations of the left coronary artery in cadaveric hearts. Int J Curr Res Rev. 2013;5(12):39-44.
Green GE, Bernistes M, Reppert EH. The length of the left main coronary artery. Surgery. 1967;62(6):1021-4.
James TN. Anatomy of the coronary arteries in health and disease. Circulation. 1965;32(6):1020-33.
Cavalcanti JS, de Lucena Oliveira M, Pais e Melo Jr AV, Balaban G, de Andrade Oliveira CL, de Lucena Oliveira E. Anatomic variations of the coronary arteries. Arquivos brasileiros de cardiologia. 1995;65(6):489-92.
Fiss DM. Normal coronary anatomy and anatomic variations. Appl Radiol. 2007;(Suppl Jan):14-26.
Fazliogullari Z, Karabulut AK, Unver DN, Uysal II. Coronary artery variations in Turkish cadaver hearts. Singapore Med J. 2010;51(10):775-80.
Kosar P, Ergun E, Kosar U. Anatomical variations and anomalies of coronary arteries: 64-slice CT angiographic appearances. Diagn Interv Radiol. 2009;15(4):275-83.
Kurjia HJ, Chaudhry MS, Olson TR. Coronary artery variations in a native Iraqi population. Cathet Cardiovasc Diagn. 1986;12:386-90.
Uemura H, Ho SY, Anderson RH, Yagihara T. Ventricular morphology and coronary arterial anatomy in hearts with isomeric atrial appendages. Ann Thorac Surg. 1999;67(5):1369-75.
Ramanathan L, Shetty P, Nayak SR, Krishnamurthy A, Chettiar GK, Chockalingam A. Origin of sinoatrial and atrioventricular nodal arteries in South Indians: an angiographic study. Arq Bras Cardiol. 2009;92(5):336-9.
Ortale JR, Keiralla LC, Sacilotto L. The posterior ventricular branches of the coronary arteries in the human heart. Arq Bras Cardiol. 2004;82:463-7.
Roberts W, Charles SM, Ang C, Holda MK, Walocha J, Lachman N, et al. Myocardial bridges: A meta‐analysis. Clin Anatomy. 2021;34(5):685-709.
Murtaza G, Mukherjee D, Gharacholou SM, Nanjundappa A, Lavie CJ, Khan AA, et al. An updated review on myocardial bridging. Coron Artery Dis. 2020;31(7):621-9.
Baz RO, Refi D, Scheau C, Savulescu-Fiedler I, Baz RA, Niscoveanu C. Coronary artery anomalies: a computed tomography angiography pictorial review. J Clin Med. 2024;13(13):3920.
Sternheim D, Power DA, Samtani R, Kini A, Fuster V, Sharma S. Myocardial Bridging: Diagnosis, Functional Assessment, and Management. J Am Coll Cardiol. 2021;78(22):2196-212.
Downloads
Published
How to Cite
Issue
Section
