Assessment of Anatomical Variation Regarding the Course and Termination of the Left Coronary Artery: A Direct Anatomical and Radiological Study

Background: The left coronary artery (LCA) demonstrates significant anatomical variability in its course and termination, critically influencing percutaneous coronary interventions, surgical revascularization, and congenital heart disease management. Despite its clinical importance, comprehensive data on LCA termination patterns in South Asian populations remain scarce.Objective: To evaluate the anatomical variations in the course and termination of the LCA using combined cadaveric and angiographic analysis in a Bangladeshi cohort.Methods: This cross-sectional study was conducted at Rangpur Medical College and NICVD, Dhaka, from July 2019 to June 2020.Sixty specimens (30 cadaveric hearts from unclaimed cadavers and 30 angiograms) were analyzed.Termination points, branching patterns, dominance, and variations (myocardial bridging, extramural anastomoses) were assessed.Data were analyzed using SPSS v16.0, with statistical significance at p<0.05. Results:The LCA exhibited bifurcation in 60% of cases and trifurcation in 38.3%.The left anterior descending artery (LAD) terminated at the inferior third of the posterior interventricular sulcus in 66.6% of specimens.In comparison, the circumflex artery (Cx) ended between the obtuse margin and crux in 68.3%.Myocardial bridging was observed in 53.3% of LADs.Left dominance was present in 10% of cases.The mean LCA main trunk length was 11. 29 3.75 mm, with 80% classified as medium-sized (5-15 mm). Conclusion:This study documents population-specific LCA termination patterns in Bangladeshi individuals, highlighting frequent myocardial bridging (53.3%) and predominant bifurcation patterns (60%).These findings underscore the importance of precise anatomical knowledge in preoperative planning for coronary interventions, particularly in resource-limited settings where advanced imaging may be unavailable.