ranching pattern of the left anterior descending coronary artery in a black Kenyan Population

Abstract

Branching pattern of the left anterior descending coronary artery is important in explaining variations in occurrence of coronary atherosclerosis, informing management strategies for coronary heart disease and interventional cardiology. Data on African populations are, however, scarce. Since coronary heart disease is increasing in Africa, the aim of this study was to describe branching pattern of the left anterior descending coronary artery in an indigenous Kenyan population. Two hundred and eight hearts obtained during autopsy were dissected at the Department of Human Anatomy, University of Nairobi, Kenya. The entire left anterior descending coronary artery was exposed. Number of branches, pattern of termination and level of bifurcation were determined. Images of representative patterns were taken using a high resolution digital camera. Data are presented in macrographs and tables. The number of septal and diagonal branches varied between 1 and 3. Termination occurred in the posterior interventricular sulcus in 68.8% and at the apex in 23% cases. Most common mode of terminal branching was bifurcation (76.9%) followed by trifurcation (11.3%), quadrifurcation (3.4%) and pentafurcation (1.5%). Bifurcation occurred in the distal segment in 48.8% and in the proximal segment in 15% of cases. The left anterior descending coronary artery displays high variability in number of septal and diagonal branches, level of termination, mode of terminal branching and level of terminal bifurcation. These patterns may constitute risk factors for atherosclerosis and should also be acknowledged during cardiac procedures. Pre – operative ultrasound evaluation is recommended to minimize inadvertent iatrogenic injury.

Keywords: Left anterior descending, branching, termination, atherosclerosis