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

Figures

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  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…

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  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 (%).

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  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.

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  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).