Title: Main Trunk of Left Coronary Artery: Anatomy and Clinical Implications
Authors: Deepa Diwan, Yogesh Diwan, Randhir S Chauhan, Prakash C Negi
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.76
Abstract
Introduction: Recognition of the length and variant branching pattern of LMCA is important because it may cause technical difficulties during coronary catheterization and stenting.
Methods: The Length and divisions of main trunk of left coronary artery (LMCA) were studied in patients who underwent coronary angiography for suspected coronary artery disease or for coronary intervention at a tertiary care centre in North India.
Results: The mean age of patients was 57.37 ± 10.60 years (Range 22-92 years). Long LMCA was observed in 16.41% cases and short main trunk in 9.06% cases. Division of main trunk into left anterior descending artery (LAD), left circumflex (LCx) and median artery was observed in 16% cases.
Discussion: Significant association is present between long LMCA and right dominance.
Keywords: coronary artery; coronary artery disease; coronary intervention.
1. Angelini P, Villason S, Chan AV, Diez JG. Normal and anomalous coronary arteries in humans. In: Angelini P ed. Coronary artery anomalies. A comprehensive approach. Lippincott Williams and Wilkins, Philadelphia; 1999. P. 27–29.
2. Reig J, Jornet A, Petit M. Anatomical variations of the coronary perfusion as a basis of myocardial vulnerability to coronary artery occlusion. ClinAnat1994; 7:315–323.
3. Fulton WFM. The Coronary Arteries. Thomas, Springfield, Illinois;1965. P. 64.
4. Glagov S. Hemodynamic risk factors: mechanical stress, mural architecture, medial nutrition and the vulnerability of arteries to atherosclerosis. In: The Pathogenesis of Atherosclerosis. Ed. RW Wissler and JC Geer. Williams and Wilkins, Baltimore; 1972. P. 64.
5. Lewis CM, Dagenais GR, Friesinger GC, Ross RS. Coronary arteriographic appearances in patients with left bundle-branch block. Circulation 1970; 41: 299-307.
6. Reig J, Petit M. Main trunk of the left coronary artery: anatomic study of the parameters of clinical interest. ClinAnat 2004; 17:6–13.
7. Gazetopoulos N, Ioannidis PJ, Karydis C, Lolas C, Kiriakou C, Tountas C. Short left coronary artery trunk as a risk factor in the development of coronary atherosclerosis. Pathological study. Brit Heart J 1976; 38:1160-1165.
8. McAlpine WA. Heart and coronary arteries. Berlin, Heidelberg, New York: SpringerVerlag; 1975. P. 133-150.
9. Petit M, Reig J. ArteriasCoronarias: Aspectos Anatomo-Clínicos. Barcelona: Masson-Salvat;1993.
10. Helwing E. Untersuchungenüber die Variabilität der Länge der Arteria coronarias-inistra. Thoraxchir Vaskuläre Chirurg 1967; 15: 218-221.
11. Vlodaver Z, Amplatz K, Burchell HB, Edwards JE. Coronary heart disease. Clinical, angiographic & pathologic profiles. New York: Springer Verlag; 1976. P. 123-158.
12. Kronzon I, Deutsch P, Glassman E: Length of the left main coronary artery and its relation to the pattern of coronary arterial distribution. Am J Cardiol 1974; 34: 787-789.
13. James TN. Anatomy of the coronary arteries. New York: Paul B. Hoeber; 1961. P. 12-150.
14. Ogden JA. The origin of the coronary arteries. (abstr) Circulation 1968; 38 (suppl VI): VI-150.
15. Larsen W. Human Embryology. 1st Ed. Churchill Livingstone,New York; 1993.
16. Kulkarni JP and Mehta L. Study of angiographic anatomy of right coronary artery. 10SR JDMS 2012; 2: 39-41.
17. Baptista CA, DiDio LJ, Prates JC. Types of division of the left coronary artery and the ramus diagonalis of the human heart. Jap Heart J 1991; 32: 323–335.
18. Cavalcanti JS, De Lucena AM, Pais Mav, Balaban G, Andrade OCL, De Lucena OE. Anatomic variations of the coronary arteries. Arq Bras Cardiol 1995; 65: 489-492.
19. Kalpana R. A study of principal branches of coronary arteries in humans. J AnatSoc India 2003; 52: 137-140.
20. Cadermartiri F, Malago R, La Grutta L, Alberghina F, Palumbo A, Maffei E, Brambilla V, Pugliese F, Runza G, Midiri M, Mollet NR, Krestin G P. Coronary variants and anomalies: methodology of visualisation with 64-slice CT and prevalence in 202 consecutive patients. Radiol Med 2007;112(8): 1117-1131.
21. Kosar P, Ergun E, Ozturk C, Kosar U. Anatomic variations and anomalies of the coronary arteries: 64-slice CT angiographic appearance. Diagn Interv Radiol 2009; 15: 275-283.
22. Bazzocchi G, Romagnoli A, Sperandio M, Simonetti G. Evaluation with 64-slice CT of the prevalence of coronary artery variants and congenital anomalies: a retrospective study of 3,236 patients. Radiol Med 2011;116(5): 675-689.
23. Udhayakumar S, Yasawardene SG. A preliminary study on anatomy of the main trunk of left coronary artery of Sri Lankans. Proc Jaffna UnivInt Res Conf; 2012. P. 108.
24. Agnihotri G, Kaur M, Kalyan GS. Branching pattern of left coronary artery among North Indians. Anat J Afr 2013; 2: 145-150.
25. Ogeng’o JA, Misiani MK, Olabu BO, Waisiko BM and Murunga A. Variant termination of the left coronary artery: pentafurcation is not uncommon. Eur J Anat 2014; 18 (2): 98-101.