ANATOMIC VARIATIONS Variant origin and course of left circumflex coronary artery Arpandeep Randhawa 1 • Abhimanyu Saini 2 • Anjali Aggarwal 1,5 • Tulika Gupta 1 • Uma Nahar Saikia 3 • Manoj Kumar Rohit 4 • Daisy Sahni 1 Received: 7 June 2016 / Accepted: 21 July 2016 Ó Springer-Verlag France 2016 Abstract Variant origin of left circumflex coronary artery (LCx) from right aortic sinus is a well-recognized coronary variation, usually without any clinical consequences. However, the variant origin and trajectory of the artery may have major implications during percutaneous coronary intervention, coronary artery surgery, aortic and mitral valve replacement procedures. We observed a variant LCx in a heart specimen belonging to 45-year-female with no history of hypertension, diabetes mellitus and coronary artery disease. The artery arose along with the right coro- nary artery from a common ostium in right aortic sinus and depicted a retroaortic course. The vessel was located at the level of aortic annulus and 6.6 mm above mitral valve annulus. The degree of luminal stenosis in variant LCx was higher than that in right coronary artery (RCA) and left anterior descending artery (LAD). Appropriate anatomical knowledge of the location and course of variant LCx is important for successful coronary interventions and valve replacement procedures. Keywords Variant left circumflex coronary artery Á Atherosclerosis Á Percutaneous coronary intervention Á Prosthetic valve replacement Introduction Variant origin and course of left circumflex coronary artery (LCx) have been described by various angiographic and cadaveric studies with a prevalence of 0.3–0.8 % [13]. Variant origin of the LCx from the opposite aortic sinus presents three patterns of origin. There may be separate ostia for right coronary artery (RCA) and LCx in right aortic sinus, a common ostium for both arteries in the right aortic sinus or LCx arises as a branch of proximal RCA [8]. Although the variant LCx is considered as a benign con- dition, the artery is susceptible to damage during surgical and transcatheter aortic and mitral valve replacement pro- cedures [10, 11]. Secondly, occurrence of this variation indicates the need of careful coronary catheterization and interpretation of angiograms [13]. Recognition and proper demonstration of this variation may help in successful accomplishment of valve surgeries as well as percutaneous and surgical interventions on this vessel when required. The present case study attempts to describe the detailed anatomy and histology of variant LCx with emphasis on its course, spatial relation with aortic and mitral valve annulus. Case presentation In a study on 150 cadaveric hearts conducted in the Department of Anatomy, PGIMER, Chandigarh, we found a case of 45-year-female with variant origin of LCx. & Anjali Aggarwal anjli_doc@yahoo.co 1 Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India 2 Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA 3 Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India 4 Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India 5 #123-c Type IV Flats, Sector 24 A, Chandigarh 160023, India 123 Surg Radiol Anat DOI 10.1007/s00276-016-1726-6