Morphological Variations of the Left Coronary Artery: A Cadaveric Study

Background/Objectives: Ischemic injury resulting from the blockage of the left coronary artery or its terminal left anterior descending and circumflex branches is associated with relatively high rates of morbidity and mortality. Variations in left coronary artery size and the number of terminal branches may in part influence the development of such blockages due to altered intraluminal fluid dynamics, while also potentially complicating medical imaging interpretation or preoperative planning for interventions of coronary circulation. While left coronary artery morphology has been extensively reported on, the results reveal substantial geographical variability, with the Eastern United States being largely underrepresented. Methods: We aimed to establish baseline measurements of left coronary artery length and width and the prevalence of variable branching patterns by examining 101 cadaveric hearts from adult, whole-body donors (59 F, 42 M) that were ethically willed to the State of Virginia. Results: The most common terminal branching pattern was left coronary artery bifurcation (n = 54), followed by trifurcation (n = 45), tetrafurcation (n = 1), and aberrant circumflex artery origin, with the left coronary artery traveling in the anterior interventricular sulcus without branching (n = 1). Compared to females, the left coronary artery of males was significantly longer (x¯ = 14.87 mm ± 5.73 mm vs. x¯ = 12.64 mm ± 4.79; p = 0.04) and wider (x¯ = 6.31 mm ± 1.10 mm vs. x¯ = 5.54 mm ± 0.90 mm; p < 0.01), regardless of terminal branching pattern. Conclusions: These results can support the interpretation of coronary angiograms and the preoperative planning of surgical interventions involving coronary vasculature.