• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of cardiodisCurrent IssueSee also Texas Heart Institute Journal in PMCSubscribeSubmissionsThe Journal Web Site
Cardiovasc Dis. Dec 1980; 7(4): 357–370.
PMCID: PMC287879

Variations in coronary artery anatomy: Normal versus abnormal


We offer a comprehensive classification of coronary artery anomalies, together with angiographic examples of each entity. Minimal requirements for normality include the following criteria: (1) the dual aortic origin is from right and left coronary ostia; (2) the course of the right coronary artery follows the right atrioventricular groove; (3) the course of the left coronary artery follows the left atrioventricular groove and anterior interventricular groove; (4) the posterior descending branch originates from either the right or left coronary artery; (5) the major coronary branches flow epicardially; and (6) the coronary arteries terminate at the myocardial capillary level. This conception of “normal” coronary arteries has determined the classification of abnormalities presented here.

Early and correct diagnosis of anomalies that may compromise the myocardial blood supply is stressed, and possible surgical solutions are offered. Selective coronary angiography is the technique of choice for precise visualization of the coronary artery system.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (3.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Baltaxe HA, Wixson D. The incidence of congenital anomalies of the coronary arteries in the adult population. Radiology. 1977 Jan;122(1):47–52. [PubMed]
  • Bertrand ME, Carré A, Ginestet A, Lefebvre JM, Warembourg H. Les anomalies congénitales des artères coronaires. Ann Cardiol Angeiol (Paris) 1976 Jan-Feb;25(1):39–58. [PubMed]
  • Chaitman BR, Lespérance J, Saltiel J, Bourassa MG. Clinical, angiographic, and hemodynamic findings in patients with anomalous origin of the coronary arteries. Circulation. 1976 Jan;53(1):122–131. [PubMed]
  • El-said GM, Dawson JT, Jr, Sandiford FM, Mullins CE, Hallman GL, Cooley DA, McNamara DG. Coronary artery anomalies. Diagnosis, indications and results of surgical management. Eur J Cardiol. 1973 Sep;1(1):63–70. [PubMed]
  • Engel HJ, Torres C, Page HL., Jr Major variations in anatomical origin of the coronary arteries: angiographic observations in 4,250 patients without associated congenital heart disease. Cathet Cardiovasc Diagn. 1975;1(2):157–169. [PubMed]
  • Kimbiris D, Iskandrian AS, Segal BL, Bemis CE. Anomalous aortic origin of coronary arteries. Circulation. 1978 Oct;58(4):606–615. [PubMed]
  • Levin DC, Fellows KE, Abrams HL. Hemodynamically significant primary anomalies of the coronary arteries. Angiographic aspects. Circulation. 1978 Jul;58(1):25–34. [PubMed]
  • Di Guglielmo L, Montemartini C. Variations anatomiques et anomalies congénitales des artères coronaires. Expérience personnelle. Ann Radiol (Paris) 1975 Apr;18(3):255–257. [PubMed]
  • Trivellato M, Angelini P, Lufschanowski R, Leachman R, Cooley DA. Origine anomala dell'arteria coronaria sinistra dall'arteria polmonare. G Ital Cardiol. 1976;6(4):717–725. [PubMed]
  • Wilson CL, Dlabal PW, Holeyfield RW, Akins CW, Knauf DG. Anomalous origin of left coronary artery from pulmonary artery. Case report and review of literature concerning teen-agers and adults. J Thorac Cardiovasc Surg. 1977 Jun;73(6):887–893. [PubMed]
  • Mikaeloff P, Loire R, Amiel M, Saint-Pierre A, Allouache K, Leoni F, Delahaye JP. Anomalie de naissance de l'artère circonflexe. Incidence sur le risque du remplacement valvulaire mitral et mitro-aortique. Arch Mal Coeur Vaiss. 1979 Aug;72(8):895–898. [PubMed]
  • Roberts WC, Morrow AG. Compression of anomalous left circumflex coronary arteries by prosthetic valve fixation rings. J Thorac Cardiovasc Surg. 1969 Jun;57(6):834–838. [PubMed]
  • Benson PA. Anomalous aortic origin of coronary artery with sudden death: case report and review. Am Heart J. 1970 Feb;79(2):254–257. [PubMed]
  • Cheitlin MD, De Castro CM, McAllister HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva, A not-so-minor congenital anomaly. Circulation. 1974 Oct;50(4):780–787. [PubMed]
  • Cohen LS, Shaw LD. Fatal myocardial infarction in an 11 year old boy associated with a unique coronary artery anomaly. Am J Cardiol. 1967 Mar;19(3):420–423. [PubMed]
  • Jokl E, McClellan JT, Williams WC, Gouze FJ, Bartholomew RD. Congenital anomaly of left coronary artery in young athletes. Cardiologia. 1966;49(5):253–258. [PubMed]
  • McClellan JT, Jokl E. Congenital anomalies of coronary arteries as cause of sudden death associated with physical exertion. Am J Clin Pathol. 1968 Aug;50(2):229–233. [PubMed]
  • NICOD JL. Anomalie coronaire et mort subite. Cardiologia. 1952;20(3):172–179. [PubMed]
  • Pedal I. Aortale Ursprungsanomalie einer Koronararterie. Ursache für den plötzlichen Herztod eines zehnjährigen Mädchens. Dtsch Med Wochenschr. 1976 Oct 29;101(44):1601–1604. [PubMed]
  • Liberthson RR, Dinsmore RE, Fallon JT. Aberrant coronary artery origin from the aorta. Report of 18 patients, review of literature and delineation of natural history and management. Circulation. 1979 Apr;59(4):748–754. [PubMed]
  • Solignac A, Saltiel J, Bourassa MG. Anomalies de distribution des artères coronaires et ischémie myocardique. A propos de deux cas. Arch Mal Coeur Vaiss. 1974 May;67(5):529–535. [PubMed]
  • Thompson SI, Vieweg WV, Alpert JS, Hagan AD. Anomalous origin of the right coronary artery from the left sinus of Valsalva with associated chest pain: report of two cases. Cathet Cardiovasc Diagn. 1976;2(4):397–402. [PubMed]
  • Leberthson RR, Dinsmore RE, Bharati S, Rubenstein JJ, Caulfield J, Wheeler EO, Harthorne JW, Lev M. Aberrant coronary artery origin from the aorta. Diagnosis and clinical significance. Circulation. 1974 Oct;50(4):774–779. [PubMed]
  • Sacks JH, Londe SP, Rosenbluth A, Zalis EG. Left main coronary bypass for aberrant (aortic) intramural left coronary artery. J Thorac Cardiovasc Surg. 1977 May;73(5):733–737. [PubMed]
  • Newton MC, Jr, Burwell LR. Single coronary artery with myocardial infarction and mitral regurgitation. Am Heart J. 1978 Jan;95(1):126–127. [PubMed]
  • Binet JP, Guiraudon G, Langlois J, Piot C, Vachon J, Grosgogeat Y. Angine de poitrine et ponts musculaires sur l'artère interventriculaire antérieure. A propos de 3 cas opérés. Arch Mal Coeur Vaiss. 1978 Mar;71(3):251–258. [PubMed]
  • Cucchini F, Di Donato M, Marelli GL, Rigatelli G, Volta G, Barbaresi F, Visioli O. I "ponti" miocardici. Una nuova problematica patogenetica nell'angina senza ostruzione coronarica. G Ital Cardiol. 1976;6(7):1166–1176. [PubMed]
  • Faruqui AM, Maloy WC, Felner JM, Schlant RC, Logan WD, Symbas P. Symptomatic myocardial bridging of coronary artery. Am J Cardiol. 1978 Jun;41(7):1305–1310. [PubMed]
  • Grondin P, Bourassa MG, Noble J, Petitclerc R, Dydra I. Successful course after supraarterial myotomy for myocardial bridging and milking effect of the left anterior descending artery. Ann Thorac Surg. 1977 Nov;24(5):422–429. [PubMed]
  • Ishimori T, Raizner AE, Chahine RA, Awdeh M, Luchi RJ. Myocardial bridges in man: clinical correlations and angiographic accentuation with nitroglycerin. Cathet Cardiovasc Diagn. 1977;3(1):59–65. [PubMed]
  • Krajcer Zvonimir, Leachman Robert D. TRANSIENT ISCHEMIC EVENTS OF THE HEART (ANGINA PECTORIS). Cardiovasc Dis. 1977;4(2):135–148. [PMC free article] [PubMed]
  • Loures JB, Sousa JE, Pimentel WA, Freire RJ, Büchler JR, Gizzi JC, Fontes VF, Jatene AD. Estudo hemodinâmico e metabólico de pacientes com ponte miocárdica na artéria descendente anterior. Arq Bras Cardiol. 1978 Jun;31(3):159–165. [PubMed]
  • Noble J, Bourassa MG, Petitclerc R, Dyrda I. Myocardial bridging and milking effect of the left anterior descending coronary artery: normal variant or obstruction? Am J Cardiol. 1976 Jun;37(7):993–999. [PubMed]

Articles from Cardiovascular Diseases are provided here courtesy of Texas Heart Institute


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...