INTRODUCTION TO CORONARY ANATOMY

Coronary anatomy
The aortic valve has three leaflets, each having a cusp or cup-like configuration. These are known as the left coronary (LC), right coronary (RC) and the posterior non-coronary (NC) cusps. The latter is called a non-coronary cusp because a coronary artery artery does not commonly originate from this cusp. The left coronary artery arises from the left coronary cusp and the the right coronary artery arises from the right coronary cusp.

Coronary anatomy

The left coronary artery usually divides into two branches, known as the left anterior descending (LAD) and the circumflex (Cx) coronary arteries. In some patients, a third branch arises in between the LAD and the Cx. This is known as the ramus,intermediate, or optional diagonal coronary artery

Right coronary artery

After its origin from the right sinus of valsalva, the RCA emerges from under the right atrial appendage to travel in the right atrioventricular groove to the Crux( i.e,the junction of four cardiac chambers).

1. First branch is Conus artery in of the cases.It supplies the right ventricular out flow tract. In the other half it has separate origin

RCA CONT..

Sinoatrial branch- it courses posteriorly Acute Marginal br.- It arises as the RCA runs in the atrioventricular groove, supplies the right ventricle Posterior descending artery (PDA)It is the first branch to supply the LV and is recognized by the septal branches that come off it

RCA

cont..

Atrioventricular artery- arise just distal to PDA Posterolateral artery- it supplies the poterolateral left ventricle

Left coronary artery

Arises as the left main (LM) artery from left sinus of Valsalva, it runs behind the pulmonary trunck and it bifucates into Left anterior descending (LAD) and Left circumflex (LCX) LAD- runs in the anterior interventricular groove, its major brs. Are Septal arteries run down into the septum Diagonal arteries- course over the antero-lateral wall of left ventricular

Left Anterior Descending

LAD usually extends to the left ventricular apex, but it can extend around the apex onto the inferior wall. LAD can be divided into three segments.

The proximal segment extends from the origin to the first major septal branch; the remainder of LAD is equally divided into mid and distal segments. The diagonals and septals are numbered sequentially (e.g, S1,S2, D1, D2).

Left circumflex artery

LCX runs in the posterior atrioventricular groove. About 45% of times SA node artery arise from LCX. Major branches are Obtuse marginal branches which supply the lateral wall of LV. Proximal LCX extends from origin to the first OM,mid LCX between first and second OM and distal LCX after origin of second OM.

CORONARY DOMINANCE
In most patients inferior and posterolateral walls of the LV are supplied by the RCA. If the PDA and PLV arise from RCA , this is called Right dominance. If they arise from LCX , it is Left dominance. If the PLV comes from RCA and PDA from LCX this called Co-dominance.