Coronary artery dual ostia

Coronary Angiography
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Anatomy & Projection Angles
Normal Anatomy Coronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus
Anatomic Variants Separate Ostia Anomalous Origins Case Example Fistula
Projection Angles Standard Views Left Coronary Artery Right Coronary Artery
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Lesion Complexity
ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis
Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6
Lesion Morphology Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration
Left ventriculography
Technique Quantification of LV Function Quantification of Mitral Regurgitation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Synonyms and keywords: Separate ostia

Overview

In cases of dual ostia, the left anterior descending artery (LAD) and left circumflex artery (LCx) arise from separate but adjacent ostia in the left sinus of Valsalva. This anomaly is considered as one of the most common benign anatomic variants of the coronary system.

Dual Ostia

The length of the left main coronary artery may vary from 1 mm to 10 mm. Occasionally, the left anterior descending artery (LAD) and left circumflex artery (LCx) may have separate openings in the left sinus of Valsalva. The anomaly generally does not cause hemodynamic alterations and the vessels are otherwise normal regarding to the territory they supply.

Epidemiology and Demographics

Dual ostia is reported to account for about 0.4% of the cases in a review and is considered as the most common benign coronary anomalies. This anomaly is found with increased incidence in the left-dominant coronary system as well as in aortic valve diseases.

Angiographic Considerations

Angiographically, it may be difficult to determine whether the left main coronary artery is short or absent and a LAO caudal projection is usually obtained to provide optimal view to make the distinction. In cases of dual ostia, LAD generally has a more anterior and superior trajectory and selective engagement with the Judkins left (JL) catheter may be achieved by counterclockwise manipulations. The opposite maneuver can be used for selective cannulation of the LCx.

Additional Images

LAD = Left anterior descending artery; LCx = Left circumflex artery

References

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