Variant termination of the left coronary artery: pentafurcation is not uncommon

Abstract

Variant termination of the left coronary artery is important in interpreting effects of its occlusion, and in guiding cardiac surgery and intervention procedures. It also constitutes a geometric risk factor for atherosclerosis. These features show ethnic variations, but data from African populations are scarce. This study therefore aimed at describing the variant patterns of termination of the left coronary artery in an indigenous Kenyan population. Left coronary arteries of 208 formalin-fixed hearts were studied by dissection at the Department of Human Anatomy, University of Nairobi. The number of terminal branches was recorded. Images of representative patterns were taken using a high resolution camera. Frequencies were calculated. Results are presented using tables and macrographs. Single left coronary arteries from the left aortic sinus were present in all the 208 hearts studied. The most frequent termination pattern was bifurcation (54.8%), followed by trifurcation (32.2%), quadrifurcation (9.6%) and pentafurcation (3.4%). Over 45% of left coronary arteries have variant patterns of termination. Pentafurcation is not uncommon. This calls for extra caution during interventional coronary artery angiography, instrumentation and surgery. Preoperative angiographic evaluation is recommended.