Anatomical Diversification of Left Coronary Artery and Its Branches in Western Maharashtra Population

Abstract Background: The right and left coronary arteries are the branches arising from the ascending aorta. They lie within subendocardial fibrofatty tissue and supply blood to the heart. The left coronary artery (LCA) originates from the left coronary sinus and splits into two branches, the circumflex artery (CX) and the left anterior descending artery (LAD) also called the anterior interventricular artery (AIVA). Furthermore, among the two coronary arteries, the LCA exhibits noticeable variation concerning its origin, length, branching pattern, level of termination, and mode of termination of its branches. Our study aimed to determine the number and position of coronary orifices in the aortic sinuses, morphometry of LCA, AIVA, and CX arteries, the branching pattern of LCA, and the prevalence of coronary dominance. Methodology: Sixty-two well-embalmed formalin-fixed cadaveric hearts were included in the study and dissected over 20 months. After opening the thoracic cavity, the heart was removed from the cadaver, and the LCA was identified, its two main branches, the AIVA and the CX artery, were traced in the anterior interventricular grooves and the left part of the anterior atrioventricular groove, respectively. The location of coronary ostia of LCA was identified and the length and branching pattern of LCA along with its branches were noted. Subsequently, the diameters of LCA, AIVA, and CX were noted, and the posterior interventricular artery was identified and analyzed to determine coronary dominance. Results: Out of 62 cadaveric hearts, the outer luminal diameters of LCA, CX, and AIVA were found to range between 2 and 3.8 mm, 2 and 3.6 mm, and 1.8 and 3.4 mm, respectively. The length of the principal trunk of LCA was measured between 1.13 mm and 10.18 mm. The LCA was bifurcating in 36 hearts (58%), the LCA was trifurcating in 22 hearts (35.4%), and the LCA showed quadrifurcation in 04 hearts (6.4%). In addition, 02 hearts (3.2%) exhibited left dominance, and 60 hearts (96.8%) had right dominance. Conclusions: With the latest developments made in the field of cardiothoracic surgery to achieve myocardial reperfusion during an event of coronary artery occlusion, the need for a thorough understanding of coronary artery variability is mandatory. Diagonal arteries form important collateral circulation. If atherosclerosis occurs in diagonal arteries, adjacent parts of LAD and CX are also affected. In quadrifurcation and trifurcation, diagonal arteries are not in their usual anatomical position, and the procedure of stenting becomes difficult at times.