ANATOMICAL VARIATION OF THE LEFT CORONARY ARTERY: DESCRIPTION OF A CASE OF TRIFURCATION WITH INTERMEDIATE BRANCH
DOI:
https://doi.org/10.56238/arev7n9-244Keywords:
Left Coronary Artery, Intermediate Branch, AnatomyAbstract
The left coronary artery (LCA), in its classic pattern, divides into two main branches: the anterior interventricular and circumflex branches. However, anatomical variations can occur, including the presence of additional branches, commonly referred to as intermediate branches. This study describes a case of LCA trifurcation, identified during routine dissection of a specimen belonging to the Human Anatomy Laboratory of the Amazonas State University. After exposure of the coronary system, the emergence of an intermediate branch was observed, which was subjected to morphometric analysis using a digital caliper. The vessel measured 1.8 mm in diameter, 39.2 mm in length, and originated approximately 14.2 mm from the beginning of the LCA. Although bifurcation is the most prevalent form of branching, the occurrence of trifurcation reinforces the morphological complexity and diversity of coronary variations. Furthermore, although often not associated with functional repercussions, such variations may, under specific circumstances, represent a predisposing factor for atherosclerosis and ischemic events, highlighting the importance of their anatomical documentation.
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References
Abuchaim, D. C. S., et al. (2009). Coronary dominance patterns in the human heart investigated by corrosion casting. Brazilian Journal of Cardiovascular Surgery, 24(4), 514–518.
Agrawal, H., et al. (2017). Anatomic types of anomalous aortic origin of a coronary artery: A pictorial summary. Congenital Heart Disease, 12(5), 603–606. DOI: https://doi.org/10.1111/chd.12518
Altin, C., et al. (2015). Coronary anatomy, anatomic variations and anomalies: A retrospective coronary angiography study. Singapore Medical Journal, 56(6), 339–345. DOI: https://doi.org/10.11622/smedj.2014193
Chen, X., et al. (2020). Image-based morphometric studies of human coronary artery bifurcations with/without coronary artery disease. Computer Methods in Biomechanics and Biomedical Engineering, 24(7), 740–752. DOI: https://doi.org/10.1080/10255842.2020.1850702
de Souza Batista, A. V., Porto, E. A., & Molina, G. P. (2011). Estudo da anatomia da artéria coronária esquerda e suas variações: Perspectivas de nova classificação. Revista Saúde & Ciência, 2(1), 55–65.
Diwan, D., et al. (2017). Main trunk of left coronary artery: Anatomy and clinical implications. Journal of Medical Sciences and Clinical Research, 5(1), 15658–15663. DOI: https://doi.org/10.18535/jmscr/v5i1.76
Galbraith, E. M., et al. (2010). Comparison of location of “culprit lesions” in left anterior descending coronary artery among patients with anterior wall ST-segment elevation myocardial infarction having ramus intermedius coronary arteries versus patients not having such arteries. The American Journal of Cardiology, 106(2), 162–166. DOI: https://doi.org/10.1016/j.amjcard.2010.02.027
Ghadri, J. R., et al. (2014). Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. BMC Cardiovascular Disorders, 14, 81. https://doi.org/10.1186/1471-2261-14-81 DOI: https://doi.org/10.1186/1471-2261-14-81
He, Y., et al. (2018). Validation of the V-RESOLVE (Visual Estimation for Risk Prediction of Side Branch Occlusion in Coronary Bifurcation Intervention) score system. Catheterization and Cardiovascular Interventions, 91(S1), 591–598. DOI: https://doi.org/10.1002/ccd.27499
Hosapatna, M., et al. (2013). Anatomical variations in the left coronary artery and its branches. Singapore Medical Journal, 54(1), 49–52. DOI: https://doi.org/10.11622/smedj.2013012
Koşar, P., et al. (2009). Anatomic variations, and anomalies of the coronary arteries: 64-slice CT angiographic appearance. Diagnostic and Interventional Radiology, 15(4), 275–283. DOI: https://doi.org/10.4261/1305-3825.DIR.2550-09.1
Kovacevic, M., et al. (2021). Left main trifurcation and its percutaneous treatment: What is known so far? Circulation: Cardiovascular Interventions, 14(3), e009872. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009872 DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.120.009872
Loukas, M., et al. (2009). The normal and abnormal anatomy of the coronary arteries. Clinical Anatomy, 22(1), 114–128. DOI: https://doi.org/10.1002/ca.20761
Reig, J., & Petit, M. (2004). Main trunk of the left coronary artery: Anatomic study of the parameters of clinical interest. Clinical Anatomy, 17(1), 6–13. DOI: https://doi.org/10.1002/ca.10162
Santos, R. M. de S., et al. (2023). Variações anatômicas nas artérias coronárias. Variações Anatômicas: O Avanço da Ciência no Brasil, 1(1), 219–229. DOI: https://doi.org/10.37885/221211606
Sharma, B., Chang, A., & Red-Horse, K. (2017). Coronary artery development: Progenitor cells and differentiation pathways. Annual Review of Physiology, 79(1), 1–19. DOI: https://doi.org/10.1146/annurev-physiol-022516-033953
