Anat Cell Biol.  2019 Sep;52(3):340-343. 10.5115/acb.19.018.

Independent origin of anterior interventricular and left marginal arteries from the left posterior aortic sinus

• Shetty P
• Nayak SB

• KMID: 2459551
• DOI: http://doi.org/10.5115/acb.19.018

Abstract

We present a unique, unreported variation of the left coronary artery. During dissection classes for first-year medical students, we observed the absence of left coronary artery in an adult male cadaver aged approximately 78 years. The left aortic sinus was dilated and it gave origin to anterior interventricular and left marginal arteries independently. Left marginal artery was large and the circumflex artery arose from it. There were two independent opening for anterior interventricular and left marginal arteries in the left posterior aortic sinus. No variations were found in the origin and branching pattern of right coronary artery and the walls and chambers of the heart.

Keyword

Coronary artery; Ascending aorta; Anterior interventricular; Circumflex; Heart

MeSH Terms

Adult
Aorta
Arteries*
Cadaver
Coronary Vessels
Heart
Humans
Male
Sinus of Valsalva*
Students, Medical

Figure

• 

  Fig. 1 Dissection of the left side of the heart showing the independent origin of anterior interventricular artery (AIVA) and left marginal artery (LMA) from the left aortic sinus (AS). AA, ascending aorta; CA, circumflex artery; LA, left atrium; PT, pulmonary trunk; RA, right auricle; SVC, superior vena cava.

• 

  Fig. 2 Closer view of the dissection of the left side of the heart showing the independent origin of anterior interventricular artery (AIVA) and left marginal artery (LMA) from the ascending aorta (AA). CA, circumflex artery; LV, left ventricle; PT, pulmonary trunk.

• 

  Fig. 3 Dissection of the left posterior aortic sinus showing separate openings for the anterior interventricular artery (AIVA) and the left marginal artery (LMA).

• 

  Fig. 4 Diaphragmatic surface of the heart showing the terminal parts of the right and left coronary arteries. LCA, left coronary artery; MCV, middle cardiac vein; PIVA, posterior interventricular artery; RCA, right coronary artery; TBLCA, terminal branches of left coronary artery; TBRCA, terminal branches of right coronary artery.

• 

  Fig. 5 A simplified schematic diagram showing both anterior and posterior surfaces of the heart with variant coronary arteries. AIVA, anterior interventricular artery; CA, circumflex artery; LMA, left marginal artery; LPAS, left posterior aortic sinus; PIVA, posterior interventricular artery; RAS, right aortic sinus; RCA, right coronary artery.

Reference

1. Shaikh SSA, Deshmukh V, Patil V, Khan Z, Singla R, Bansal NO. Congenital absence of the left circumflex artery with super-dominant right coronary artery: extremely rare coronary anomaly. Cardiol Res. 2018; 9:264–267.

2. Svensson A, Themudo R, Cederlund K. Anomalous origin of right coronary artery from the pulmonary artery. Eur Heart J. 2017; 38:3069.

3. Brenner E, Pechriggl E, Zwierzina M, Hormann R, Moriggl B. Case report: a common trunk of the coronary arteries. Surg Radiol Anat. 2017; 39:455–459.

4. Kultida CHY, Ruedeekorn SW, Keerati HS. Anatomic variants and anomalies of coronary arteries detected by computed tomography angiography in southern Thailand. Med J Malaysia. 2018; 73:131–136.

5. Cortes M, Roldan CA, Clegg S. Unusual congenital coronary artery anomaly in a young adult presenting as sudden cardiac arrest. BMJ Case Rep. 2018; 2018:bcr-2017-221995.

6. Fugar S, Issac L, Okoh AK, Chedrawy C, Hangouche NE, Yadav N. Congenital absence of left circumflex artery: a case report and review of the literature. Case Rep Cardiol. 2017; 2017:6579847.

7. Saglam M, Dogan D, Sahin S, Turkkan C, Kula O. Single right coronary artery with absence of the left main coronary artery, left anterior descending artery, and circumflex artery. Echocardiography. 2017; 34:1401–1403.

8. Iliev A, Kotov G, Dimitrova IN. A rare case of multiple anomalies of the coronary arteries. Cureus. 2018; 10:e2796.

9. Coşansu K, Tarık Ağaç M, Kılıç H, Akdemir R, Gündüz H. Twin circumflex arteries: a rare coronary artery anomaly. J Tehran Heart Cent. 2018; 13:32–34.