Coronary artery anomalies overview: The normal and the abnormal

Table 1 Main characteristic of the 3 main coronary arteries

	Dependent territory	Course	Branches
RCA	RV free wall	Right AV sulcus	At least the acute marginal branch
LAD	Anterior IV septum	Anterior IV sulcus	Septal penetrating branches
LCX	LV free wall	Left AV sulcus	At least 1 obtuse marginal branch

RCA: Right coronary artery; LAD: Left anterior descending; LCX: Left circumflex artery; RV: Right ventricle; IV: Interventricular; LV: Left ventricle; AV: Atrioventricular.

Table 2 Normal features of the coronary anatomy in humans, modified from[10]

Feature	Range
Number of ostia	2 to 4
Location	Right and left anterior sinuses (upper midsection)
Proximal orientation	45° to 90° off the aortic wall
Proximal common stem or trunk	Only left (LAD and LCX)
Proximal course	Direct, from ostium to destination
Mid-course	Extramural (subepicardial)
Branches	Adequate for the dependent myocardium
Essential territories	RCA (RV free wall)
	LAD (anteroseptal)
	OM (LV free wall)
Termination	Capillary bed

LAD: Left anterior descending artery; LCX: Left circumflex artery; RCA: Right coronary artery; RV: Right ventricle; OM: Obtuse marginal artery; LV: Left ventricle.

Table 3 Comparison of trans-septal and interarterial coronary arteries[14]

	Trans-septal	Interarterial
Artery surrounding	Septal myocardium	Epicardial fat
Course downward	Yes (hammock sign)	No
Oblong orifice	No	Possible

Table 4 Classification of coronary artery anomalies based on anatomical features

Coronary artery anomalies
Of ostium	Ostial atresia
	valve-like ridge
Of origin	From PA		RCA from PA
			LMCA from PA
			LAD from PA
			All from PA
			Accessory cor. from PA
	From aorta	SCA	SCA from LSV
			SCA from RSV
		RCA	RCA ectopic from RSV
			RCA from LSV
			RCA from PSV
		LMCA	LMCA from PSV
		LAD	LAD from RCA
			LAD from RSV
		LCX	LCX from RSV
			LCX from RCA
Of anatomy	Duplication		Duplication of RCA
			Duplication of LAD
			Duplication of LCX
Congenital absence	Congenital absence of LMCA
	Atresia LMCA
	Congenital absence of LCX
Hypoplasia	Hypoplasia of RCA and LCX
Of termination	Fistulae
	Systemic termination

PA: Pulmonary artery; RCA: Right coronary artery; LMCA: Left main coronary artery; LAD: Left anterior descending; SCA: Single coronary artery; LSV: Left sinus of Valsalva; RSV: Right sinus of valsalva; PSV: Posterior sinus of Valsalva; LCX: Left circumflex artery.