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 .
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.
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 .
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.