Dr.S.Venkatesan MD

It is a well known anatomical fact  the grooves in the heart

• Right and left  Atrio ventricular grooves.
• Anterior  and posterior  inter-ventricular   grooves.

sincerely carry the  main stem of right and left coronary artery . It can be compared to a train running   with dedication   on its track .

Image source : AJR June 2007 vol. 188 no. 6 1665-1674

But God has not  enforced  strict rules   especially in human biology . The coronary arteries in few individuals   wander away  from the grooves.

This is very common  for Left circumflex  , followed by  RCA.  It is  relatively  for LAD to jump out of  its groove.(Except in rare Dual LAD system)

Here is a right coronary artery which enjoys its journey outside the right AV groove for   a good distance , only  rejoin the  groove at the crux.

Importance of  “Non- Grooval” coronary artery

It is true large diagonals and OMs ,ramus do   run without any  special tracks  .  But ,  it becomes ab  entirely different issue  when  the main stem of RCA,LCX or LAD itself   derail from its groove. There is no  fixing agents or vascular sheaths  that keep the coronary arteries within the groove. Surgeons  tell us circumflex is  often absent in its groove.

Note the stress and strain on the mid RCA : What will happen if that segemnt requires a stent ?

Hemodynamic implication of such free flowing non grooval coronary arteries is not been studied much .It is also observed  these   coronary  arteries   show  a  tortuous  course.This is  important   for  the  interventionist  as stenting  these segments is fraught with excess mobility and  tortuosity induced crimping .

Final message

The prevalence  of such drifting coronary arteries from its  groove  can be much more prevalent than we would  believe . The anatomical and physiological , surgical  issues need to be explored.