Anat Cell Biol.  2018 Sep;51(3):164-173. 10.5115/acb.2018.51.3.164.

Anatomical and radiological angiographic study of the coronary ostia in the adult human hearts and their clinical significance

• Nasr AY
• El Tahlawi M

• KMID: 2447009
• DOI: http://doi.org/10.5115/acb.2018.51.3.164

Abstract

This study was carried out to investigate the morphometric parameters and variations of coronary ostia in the hearts of adult human cadavers and coronary angiographs. The hearts of 60 adult human cadavers and 400 coronary angiographs were used in this study. The root of the aorta was carefully dissected to clear aortic sinuses, coronary ostia, and sinutubular junction (STJ). Number, locations, internal diameter distance between coronary ostia and their corresponding STJ, sinus bottom, and valve commissures were investigated. The anterior aortic sinus (AAS) revealed a single ostium for right coronary artery (RCA) in 77.5% of male and 80% of female hearts. This ostium gave a common origin for RCA and third coronary artery (TCA) in 15% of male and 20% of female hearts. However, two separate ostia for RCA and TCA origin were seen in 20% of male and 15% of female hearts. Moreover, three ostia were seen in one male and one female hearts within AAS. Meanwhile, the left posterior aortic sinus showed a single ostium for left coronary artery (LCA) in 97.5% of male and 95% of female hearts and two ostia in one male and one female hearts. The ostia were commonly seen below STJ and less commonly were observed above STJ. The distance between the bottom of aortic sinus and LCA ostium was longer than that of RCA. The internal diameter of RCA ostium was significantly (P<0.05) narrower than that of LCA but with no significant sex difference. Moreover, anomalous of coronary ostia was observed in seven out 400 angiographs and in two cadaveric hearts. Knowledge the morphometric parameters and anatomical variations of coronary ostia helps the cardiac surgeons to overcome the possible difficulties that could occur during surgical and radiological coronary interventions.

Keyword

Coronary ostia; Anatomy; Angiography; Human; Cadaver

MeSH Terms

Adult*
Angiography
Aorta
Cadaver
Coronary Vessels
Female
Heart*
Humans
Humans*
Male
Sex Characteristics
Sinus of Valsalva
Surgeons

Figure

• 

  Fig. 1 Light photographs of adult cadaveric human hearts showing the root of the ascending aorta having the aortic sinuses and the ostia of coronary arteries. (A) The ascending aorta lies between the pulmonary trunk (PT) anteriorly and superior vena cava (SVC) posteriorly. It exhibits three aortic sinuses; the anterior aortic sinus (AAS), left posterior aortic sinus (LPAS), and right posterior aortic sinus (RPAS) above their corresponding aortic valve leaflets. The right coronary artery (RCA) and third coronary artery (TCA) originate from AAS through a common ostium, while the left coronary artery (LCA) originates from LPAS through single ostium. AIVA, anterior interventricular. (B) The ostium of the RCA (O) is surrounded by three lines (A–C) that represent the distance between the ostium and the bottom of the sinus vertically and the commissures of valve leaflets at both sides. The ostium of RCA is seen below sinu-tubular junction (STJ) within the AAS. Also, the ostium of LCA is seen below STJ within LPAS. (C) The ostia of both RCA (RCAO) and LCA (LCAO) are seen below the STJ within the corresponding aortic sinus. (D) The AAS shows two ostia below the STJ; one for RCA (RCAO) and the other for the third coronary artery origin (TCAO). (E) The ostia of both RCA (RCAO) and LCA (LCAO) are seen at the level of the STJ. (F) Both RCAO and TCAO are seen within AAS below STJ, while LCAO is present within the LPAS below STJ.

• 

  Fig. 2 The numerical and positional incidence of the coronary ostia in the cadaveric hearts (%). (A) The incidence of single ostium in the anterior aortic sinus (AAS) and left posterior aortic sinus (LPAS) is represented in male, female and all cadaveric hearts. (B) The incidence of two coronary ostia in both AAS and LPAS that are observed in male, female and all cadaveric hearts (%). (C) The incidence of three coronary ostia that are recorded within both AAS and LPAS in male, female and all cadaveric hearts (%). (D) The incidence of both right coronary artery (RCA) and left coronary artery (LCA) ostia below the level of the sinutubular junction (STJ) in male, female and all cadaveric hearts (%). TCA, third coronary artery. (E) The incidence of both RCA and LCA ostia at the level of the STJ in male, female and all cadaveric hearts (%). (F) The incidence of both RCA and LCA ostia above the level of the STJ in male, female and all cadaveric hearts (%).

• 

  Fig. 3 Light photograph of cadaveric hearts showing original variations of the left coronary artery. (A) The anterior aortic sinus (AAS), left posterior aortic sinus (LPAS), and right posterior aortic sinus (RPAS) above the corresponding aortic cusps at the beginning of ascending aorta. The right coronary artery (RCA) originates from AAS and the branches of left coronary artery (LCA) originate from LPAS. The pulmonary trunk (PT) lies anterior to ascending aorta and superior vena cava (SVC) lies posterior to it. (B, C) The anterior interventricular (AIVA) and left circumflex branches (LCX) originate from LPAS through a common ostium (*) with an absence of LCA. The median branch (M) originates from LCX. (D) The large AIVA and small LCX branches of LCA originate directly from LPAS through a common ostium (*) with an absence of LCA. A median branch (M) is seen originating from AIVA.

• 

  Fig. 4 Coronary angiographs of adult male human hearts showing different original variations of coronary arteries. (A) The right coronary artery (RCA) originates from the anterior interventricular branch (AIVA) of left coronary artery (LCA). (B) The RCA originates from the left posterior aortic sinus (LPAS). (C) The RCA and left circumflex branch (LCX) originate from LPAS. LCX and AIVA originate from two separate aortic sinuses. RCAO, ostium of the right coronary artery. (D) The LCA originates from the right posterior aortic sinus (RPAS).

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  Fig. 5 Coronary angiographs of adult females showing the original anomalous of coronary arteries. (A) The right coronary artery (RCA) originates from the left circumflex branch (LCX). (B) The left coronary artery (LCA) gives only the anterior interventricular branch (AIVA). (C, D) The RCA originates from the LCX. AIVA originates from the right posterior aortic sinus (RPAS) and the LCX originates from the left posterior aortic sinus (LPAS).

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