Coronary Arteries and Their Variations: A Retrospective Study at a Tertiary Care Centre in Tamil Nadu, India

Abstract

Introduction: Anatomic variations in coronary circulation are commonly identified during dissection and angiographic procedures. The right and left coronary arteries, which supply blood to the heart, originate from the corresponding aortic sinuses. Occlusion of the coronary artery can lead to heart ischaemia, resulting in myocardial infarction and death. Understanding such variations is crucial for cardiac catheterisation, coronary artery bypass surgery, and the identification of fistulous communication, dissection, and rupture of the coronary artery. Aim: To identify the branching pattern of coronary arteries, their origin, dominance in the heart, and variations in angiographic images. Materials and Methods: The present retrospective cross-sectional study analysed 100 angiographic pictures collected from the Cardiology Department at PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India, between November 2017 and April 2018. The data were analysed from March 2022 to June 2022 to determine the origin, branching pattern, and variations of the coronary arteries. The coronary arteries and their branches were carefully traced and followed to their termination, and normal and variant anatomy were analysed. Descriptive statistics were used, and the results were expressed in frequency and percentage. Results: A total of 100 patients presented with chest pain/dyspnoea and underwent diagnostic coronary artery catheterisation in the PSG Cardiology Department. Among them, 75% were males and 25% were females, with ages ranging from 14 to 82 years (mean age of 48 years). The dominant form of coronary circulation was found to be right dominance (42%), followed by co-dominance (30%). In one study, a higher origin of the right coronary artery from the ascending aorta was observed. An anomalous vessel arising from the right coronary artery was identified in an angiogram. Separate origins of the circumflex artery and left anterior descending artery from the left coronary artery were observed in another angiogram. Fistulous communications were found in two angiograms: one between the pulmonary artery and the diagonal branch of the left anterior descending artery, and the other between the right coronary artery and the septal branch of the left anterior descending artery. Additionally, two other studies identified dissection and spontaneous rupture of the coronary artery. Conclusion: Identifying anomalous vessels and recognising other variations are crucial for appropriate intervention, treatment, and improved outcomes. Angiography can help identify and treat variations in the course and branching pattern of the coronary artery as early as possible to avoid complications.