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VOLUME 12 , ISSUE 2 ( July-December, 2023 ) > List of Articles


Anatomical Variants and Anomalies of Coronary Artery Tree as Seen in Slice Multidetector Computed Tomography (MDCT)

Poojitha Ronda, CS Prabhu, T Lokesh Kumar

Keywords : Computed tomography, Coronary artery disease, Coronary computed tomography angiography

Citation Information : Ronda P, Prabhu C, Kumar TL. Anatomical Variants and Anomalies of Coronary Artery Tree as Seen in Slice Multidetector Computed Tomography (MDCT). 2023; 12 (2):38-42.

DOI: 10.5005/jp-journals-10085-9129

License: CC BY-NC 4.0

Published Online: 02-02-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract cardiovascular diseases, especially coronary heart disease (CHD), are an epidemic in India. So, early diagnosis of coronary artery disease is necessary. There is an emerging need for the assessment of anatomical variants and anomalies of the coronary artery tree for early diagnosis of coronary artery disease. With rapid advancement of non-invasive imaging like computed tomography coronary angiography, the complex anatomy of the coronary tree is assessed. The most common type of dominant system was the right coronary dominance. The most commonly encountered variant was ramus intermedius branch. In majority, most patients with anomalies are asymptomatic and anomalies were an incidental finding on coronary angiography. Anomalous origin and course of the coronary artery were the commonly encountered of which most are benign; however, few of these anomalies were associated with sudden cardiac death (interarterial course). Other anomalies associated with sudden cardiac death included anomalous origin of the left coronary artery from the pulmonary artery, atresia of the left main stem and coronary fistulae. The aim of this article is to provide an overview of the various normal anatomy, variants, and anomalies with a brief about their clinical presentations.

  1. Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Glob Health 2016;82(2):307–315. DOI: 10.1016/j.aogh.2016.04.002.
  2. Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol 2016;8(12):728–734. DOI: 10.4330/wjc.v8.i12.728.
  3. Abdul-Aziz AA, Desikan P, Prabhakaran D, Schroeder LF. Tackling the burden of cardiovascular diseases in India: The essential diagnostics list. Circ Cardiovasc Qual Outcomes 2019;12(4):e005195. DOI: 10.1161/CIRCOUTCOMES.118.005195.
  4. Pattnayak U, Banerjee D, Madhwani KP, Singh JK. Estimation of prevalence of risk factors for coronary artery disease in a rural population in Howrah, West Bengal. Int J Community Med Public Health 2019;6(4):1793. DOI:
  5. Krishnan MN. Coronary heart disease and risk factors in India – On the brink of an epidemic? Indian Heart J 2012;64(4):364–367. DOI: 10.1016/j.ihj.2012.07.001.
  6. Wallis A, Manghat N, Hamilton M. The role of coronary CT in the assessment and diagnosis of patients with chest pain. Clin Med 2012;12(3):222–229. DOI: 10.7861/clinmedicine.12-3-222.
  7. Allajbeu I, Hajro E, Temali I, Cekrezi B, Preza K. The role of CT angiography of coronaries in early diagnosis of coronary artery plaques in Albanian people with no history of cardiovascular disease in correlation with traditional risk factors. Mater Socio-Medica 2014;26(3):163–167. DOI: 10.5455/msm.2014.26.163–167.
  8. Kini S, Bis KG, Weaver L. Normal and variant coronary arterial and venous anatomy on high-resolution CT angiography. Am J Roentgenol 2007;188(6):1665–1674. DOI: 10.2214/AJR.06.1295.
  9. Iaizzo PA, ed. Handbook of Cardiac Anatomy, Physiology, and Devices. Totowa, NJ: Humana Press; 2005. Available from: http://link. springer.
  10. Kosar P, Ergun E, Ozturk C, Kosar U. Anatomical variations and anomalies of the coronary arteries: 64-slice CT coronary angiographic appearance. Diagn Interv Radiol 2009;15(4):275–283. DOI: 10.4261/1305-3825.DIR.2550-09.1.
  11. Nerantzis CE, Marianou SK, Koulouris SN, Agapitos EB, Papaioannou JA, Vlahos LJ. Kugel's artery: An anatomical and angiographic study using a new technique. Tex Heart Inst J 2004;31(3):267–270. PMID: 15562847.
  12. Angelini P, Villason S, Chan AV. Normal and Anomalous Coronary Arteries in Humans. Coronary Anery Anorulies: A Comprehensive Approach. P. Angelini (ed). (pp: 53). Philadelphia: Lippincott Williams & Wilkins; 1999.
  13. Nguyen V, Tam W, Iskandar M, Perez V, Chizner R, Alonso R, et al. Conus branch occlusion: The masquerading widowmaker. J Am Coll Cardiol 2019;73(9):2554. DOI: 10.1136/ha.2010.003244.
  14. Ellis H. Gray's anatomy. 37th ed. P. L. Williams, R. Warwick, M. Dyson, L. H. Bannister. 305 × 235mm. Pp. 1598. Illustrated. 1989. Edinburgh: Churchill Livingstone. £70.00. Br J Surg 1989;76(12):1359–1359. DOI:
  15. Vikse J, Henry BM, Roy J, Ramakrishnan PK, Hsieh WC, Walocha JA, et al. Anatomical variations in the sinoatrial nodal artery: A meta-analysis and clinical considerations. PLoS One 2016;11(2):e0148331. DOI: 10.1371/journal.pone.0148331.
  16. Hakim J, Leesar M. Quadfurcation of the left main coronary artery: Double ramus medianus coronary system. Angiology 2004;55(1): 109–110. DOI: 10.1177/000331970405500118.
  17. Angelini P. Coronary artery anomalies: An entity in search of an identity. Circulation 2007;115(10):1296–1305. DOI: 10.1161/CIRCULATIONAHA.106.618082.
  18. Ali M, Hanley A, McFadden EP, Vaughan CJ. Coronary artery anomalies: a practical approach to diagnosis and management. Heart Asia 2011;3(1):8–12. DOI: 10.1136/ha.2010.003244.
  19. Angelini P. Coronary artery anomalies—Current clinical issues. Tex Heart Inst J 2002;29(4):271–278. PMID: 12484611.
  20. Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J 1986;111(5):941–963. DOI: 10.1016/0002-8703(86)90646-0.
  21. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990;21(1):28–40. DOI: 10.1002/ccd.1810210110.
  22. Thiene G, Nava A, Corrado D, Rossi L, Pennelli N. Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med 1988;318(3):129–133. DOI: 10.1056/NEJM198801213180301.
  23. Corrado D, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998;339(6):364–369. DOI: 10.1056/NEJM199808063390602.
  24. Burke AP, Farb A, Virmani R, Goodin J, Smialek JE. Sports-related and non-sports-related sudden cardiac death in young adults. Am Heart J 1991;121(2 Pt 1):568–575. DOI: 10.1016/0002-8703(91)90727-y.
  25. Liberthson RR. Sudden death from cardiac causes in children and young adults. N Engl J Med 1996;334(16):1039–1044. DOI: 10.1056/NEJM199604183341607.
  26. Corrado D, Thiene G, Nava A, Rossi L, Pennelli N. Sudden death in young competitive athletes: Clinicopathologic correlations in 22 cases. Am J Med 1990;89(5):588–596. DOI: 10.1016/0002-9343(90)90176-e.
  27. Villa AD, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary artery anomalies overview: The normal and the abnormal. World J Radiol 2016;8(6):537–555. DOI: 10.4329/wjr.v8.i6.537.
  28. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000;35(6):1493–1501. DOI: 10.1016/s0735-1097(00) 00566-0.
  29. Angelini P. Coronary artery anomalies: An entity in search of an identity. Circulation 2007;115(10):1296–1305. DOI: 10.1161/CIRCULATIONAHA.106.618082.
  30. Van Camp SP, Bloor CM, Mueller FO, Cantu RC, Olson HG. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc 1995;27(5):641–647. PMID: 7674867.
  31. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol 1992;20(3):640–647. DOI: 10.1016/0735-1097(92)90019-j.
  32. Baltaxe HA, Wixson D. The incidence of congenital anomalies of the coronary arteries in the adult population. Radiology 1977;122(1): 47–52. DOI: 10.1148/122.1.47.
  33. Bunce NH, Lorenz CH, Keegan J, Lesser J, Reyes EM, Firmin DN, et al. Coronary artery anomalies: Assessment with free-breathing three-dimensional coronary MR angiography Radiology 2003;227(1): 201–208. DOI: 10.1148/radiol.2271020316.
  34. Hariharan R, Kacere RD, Angelini P. Can stent-angioplasty be a valid alternative to surgery when revascularization is indicated for anomalous origination of a coronary artery from the opposite sinus? Tex Heart Inst J 2002;29(4):308–313. PMID: 12484615.
  35. Van Son JA, Haas GS. Anomalous origin of left main coronary artery from right sinus of Valsalva: Modified surgical treatment to avoid neo-coronary ostial stenosis. Eur J Cardiothorac Surg 1996;10(6):467–469. DOI: 10.1016/s1010-7940(96)80118-7.
  36. Angelini P, Walmsley RP, Libreros A, Ott DA. Symptomatic anomalous origination of the left coronary artery from the opposite sinus of valsalva. Clinical presentations, diagnosis, and surgical repair. Tex Heart Inst J 2006;33(2):171–179. PMID: 16878619.
  37. García-Rinaldi R, Sosa J, Olmeda S, Cruz H, Carballido J, Quintana C. Surgical treatment of right coronary arteries with anomalous origin and slit ostium. Ann Thorac Surg 2004;77(5):1525–1529. DOI: 10.1016/j.athoracsur.2003.08.084.
  38. Erbagci H, Davutoglu V, Turkmen S, Kizilkan N, Gumusburun E. Double right coronary artery: Review of literature. Int J Cardiovasc Imaging 2006;22:9–11. DOI: 10.1007/s10554-005-5139-6.
  39. Wann S, Schuchard G. Images in clinical medicine. Anomalous origin of the right coronary artery. N Engl J Med 2006;355(9):e8. DOI: 10.1056/NEJMicm050051.
  40. Isner JM, Shen EM, Martin ET, Fortin RV. Sudden unexpected death as a result of anomalous origin of the right coronary artery from the left sinus of Valsalva. Am J Med 1984;76(1):155–158. DOI: 10.1016/0002-9343(84)90765-4.
  41. Angelini P. A rare coronary anomaly: Double right coronary artery. Clin Cardiol 2008;31(4):186. DOI: 10.1002/clc.20240.
  42. Sawaya FJ, Sawaya JI, Angelini P. Split right coronary artery its definition and its territory. Tex Heart Inst J 2008;35(4):477–479. PMID: 19156248.
  43. Musiani A, Cernigliaro C, Sansa M, Maselli D, De Gasperis C. Left main coronary artery atresia: Literature review and therapeutical considerations. Eur J Cardiothorac Surg 1997;11(3):505–514. DOI: 10.1016/s1010-7940(96)01121-9.
  44. Roberts WC, Glick BN. Congenital hypoplasia of both right and left circumflex coronary arteries. Am J Cardiol 1992;70(1):121–123. DOI: 10.1016/0002-9149(92)91407-u.
  45. McFarland C, Swamy RS, Shah A. Hypoplastic coronary artery disease: A rare cause of sudden cardiac death and its treatment with an implantable defibrillator. J Cardiol Cases 2011;4(3):e148-e151. DOI: 10.1016/j.jccase.2011.08.005.
  46. Fraisse A, Quilici J, Canavy I, Savin B, Aubert F, Bory M. Myocardial infarction in children with hypoplastic coronary arteries. Circulation 2000;101(10):1219–1222. Available from:
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