ORIGINAL COMMUNICATION The Clinical Anatomy of the Conal Artery MARIOS LOUKAS, 1,2 * SWETAL PATEL, 1,3 ALPER CESMEBASI, 1,4 HORIA MURESIAN, 5 R. SHANE TUBBS, 1,6 DIANE SPICER, 7 AND MAREK DABROWSKI 8 1 Department of Anatomical Sciences, St. George’s University, Grenada, West Indies 2 Department of Anatomy, Varmia and Mazuria Medical School, Olsztyn, Poland 3 Department of Medicine, University of Nevada SOM, Las Vegas, Nevada 4 Departments of Neurologic and Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 5 Department of Cardiovascular Surgery, The University Hosptial of Bucharest, Romania 6 Division of Pediatric Neurosurgery, Children’s Hospital, Birmingham, Alabama 7 Department of Pediatrics-Cardiology, University of Florida, Gainesville, Florida 8 Department of Cardiology, Bielany Hospital, Warsaw, Poland Coronary arteries have been extensively described and recognized by gross anatomic studies. However, in the clinical setting, the recognition of the conal artery is essential during coronary angiography, as well as certain congenital heart conditions such as tetralogy of Fallot. In order to provide a complete ana- tomic and physiologic correlation of the actual incidence and distribution of the conal artery we examined 300 formalin fixed hearts with gross dissections and 300 coronary angiograms. The conal artery was identified in all hearts exam- ined and five main patterns were recognized. In Type A (193, 32.1%), the conal artery arose as a branch of the right coronary artery (RCA); in Type B (96, 16%), the conal artery arose from the common coronary ostium with the RCA; in Type C (242, 40.3%), the conal artery took origin from the right aortic sinus as an independent artery; in Type D (48, 8%), multiple conal arteries were present and arose from the RCA as separate branches (32, 66.6%), from a common ostium with the RCA (8, 16.6%) or from the aortic sinus (8, 16.6%); in Type E (22, 3.6%), the conal artery arose as a branch of the right ventricular branch (17, 2.8%) or acute marginal artery (5, 0.8%). The relative prevalence of the five patterns as well as the morphology and the topography of the conal artery varied significantly with the degree of coronary luminal ste- nosis (as observed during angiography) and also with the degree of hypertro- phied ventricular wall (as observed during gross dissections). Clin. Anat. 00:000–000, 2014. V C 2014 Wiley Periodicals, Inc. Key words: right coronary artery; conal artery; left anterior descending artery; right ventricular free wall; myocardial infarction; coronary anasto- mosis; conus; infundibular artery; tetralogy of Fallot repair; third coronary artery INTRODUCTION While the anatomy of the main branches of the cor- onary arteries has been characterized in depth, cer- tain smaller branches still remain controversial regarding their origin and distribution. In particular, descriptions of the conal artery are typically very brief and lacking in detail. The conal artery (synonymous to Terminologia Anatomica Rr. Coni arteriosi—Conus *Correspondence to: Marios Loukas, Department of Anatomical Sciences, St. George’s University, School of Medicine, Grenada, West Indies. E-mail: mloukas@sgu.edu Accepted under the editorship of Joel Vilensky Received 4 April 2014; Revised 21 August 2014; Accepted 26 August 2014 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22469 V V C 2014 Wiley Periodicals, Inc. Clinical Anatomy 00:00–00 (2014)