Abstract

Background: Cardiovascular disease is one of the leading causes of morbidity and mortality in the world. The aim of this study is to observe the branching pattern of left coronary artery with special attention to the origin and termination of the posterior interventricular artery(PIVA), to determine the coronary dominance and the occurrence of myocardial bridges over the anterior interventricular artery(AIVA). Myocardial bridging is a congenital anomalous condition in which a coronary artery takes a “tunneled” course under a “bridge” of overlying myocardium. The vessel is compressed in systole, resulting in angina, myocardial ischemia, acute coronary syndrome, left ventricular dysfunction, sudden cardiac death and arrhythmias. Materials and Methods: This study was taken up at the Institute of Anatomy, Madurai Medical College with 60 heart specimens collected from the cadavers of the same Institute and from the Department of Forensic Medicine. The heart specimens of different age groups, sex and socioeconomic status were preserved in 10% formalin and studied by the conventional dissection method. Results: Among the 60 heart specimens studied, left coronary artery was seen bifurcating in 62%, trifurcating in 32% and quadfurcating in 6%. Regarding dominance, right dominance with PIVA arising from right coronary artery was seen in 53 specimens (88.3%), left dominance with PIVA being the continuation of left circumflex artery(LCX) was seen in 5 specimens(8.3%) and PIVA was arising from both coronaries in 2 specimens(3.4%). Among the 5 left dominant specimens, PIVA was seen as a continuation of LCX artery in 4 and single whereas in 1 specimen the PIVA was seen to be double. With regard to termination of PIVA, it terminated in the middle of posterior interventricular sulcus(PIVS) in 2 specimens and at the junction of anterior 1/3 and posterior 2/3 of PIVS in the rest. Myocardial bridges were seen over anterior interventricular artery in 15 specimens (25%). Conclusion: Right dominance is seen in majority of hearts followed by left dominance and the balanced pattern being the least. Presence of myocardial bridges was predominantly seen over AIVA.

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