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Abstract
Brief Introduction Anatomy and functionality of the coronary circulation have been of interest to physicians ever since it emerged that mammalian hearts have their own blood supply. If asked how many coronary arteries the normal heart has, most of the medical students (and many practitioners) would answer ‘TWO’. However, the frequent presence of two right coronary artery roots is not generally well appreciated, even though it has been evident to anatomists and cardiac surgeons for centuries. The human heart is in most cases vascularized by two coronary arteries, the right and the left coronary artery. Supernumerary coronary artery, which arises independently from the right aortic sinus and passes through sub-epicardial adipose tissue of pulmonary conus and anterior side of the right ventricle; is called Third coronary artery. The Third coronary artery (TCA) is a direct branch from the Right Aortic Sinus (RAS) without any observable common trunk with the Right Coronary Artery (RCA).
Methodology This study was conducted at Department of Forensic Medicine and Toxicology, Bangalore Medical College and Research Institute, Bengaluru for a period of 6 months from January 1st 2011 to 30th June 2011. A total number of 1779 autopsy cases were performed during the study period, out of which 550 cases were selected for our study. Specimens with observable cardiac defects and decomposed cases were excluded from the study. The hearts were dissected to display the origins of the right, left and third coronary arteries. The aortic root was split posteriorly to enable a clear view of the RAS with its orifices. With the aid of dissecting lenses, the branches of the TCA were displayed and traced distally to confirm the course, branching and termination.
Results Out of the 550 hearts dissected, Third coronary artery (Figure 1) was present in 184 hearts, which amounts to 33.45%. According to the position of the third coronary artery, 83.15% was in 10‘clock position. Majority of the Third coronary artery, i.e., 78.8% had an independent course without obvious anastomosis. Multiple orifices (Figure 2) have been seen in 3 individuals. It was observed that among the 95 natural death cases, 32 cases were due to sudden natural death of cardiac origin. In these 32 cases, third coronary was present only in 3 cases.
Conclusion The most suitable term to identify supernumerary artery that arises independently from the right aortic sinus is the Third coronary artery. The present study highlights that the incidence of Third coronary artery is 33.45%. It was observed that among the 95 natural death cases, 32 cases were due to sudden natural death of cardiac origin. In these 32 cases, third coronary artery was present only in 3 cases. It implies that presence of third coronary artery is a boon to the individual and the person who has third coronary artery is less likely to die from sudden natural death due to cardiac origin.
Third Coronary Artery
Multiple Orifices
- Third coronaryartery
- Autopsy
- Incidence