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Left main coronary artery

Dr Craig Hacking ◉ ◈ and Dr Henry Knipe ◉ ◈ et al.

The left main coronary artery (LMCA) or left coronary artery (LCA) is one of the two main coronary arteries that supply the heart with oxygenated blood.

On this page:

Article:

Gross anatomy
Coronary dominance
Variant anatomy
Related articles
References

Images:

Cases and figures

Gross anatomy

Origin

It is a branch of the ascending aorta, with its normal origin in the left aortic sinus, just superior to the aortic valve ^1-2.

Course

LMCA runs for 5-10 mm as it passes to the left and posterior to the pulmonary trunk before bifurcating ^1-2.

Branches

left anterior descending artery (LAD)
left circumflex artery (LCx)

Coronary dominance

Most hearts are right dominant where the PDA is supplied by the RCA. However up to 20% of hearts may be left dominant, where the PDA is supplied by the LAD or LCx or codominant, where a single or duplicated PDA is supplied by branches of both the RCA and LAD/LCx.

For a more in depth discussion of coronary dominance, see the article coronary arterial dominance.

Variant anatomy

Anatomical variations of the LMCA include ³:

in ~15% of patients the LMCA trifurcates
- left anterior descending artery
- left circumflex artery
- ramus intermedius artery
multiple ostia: separate origin of LAD and LCx (i.e. no LCA)
single coronary artery (very rare)
anomalous origin of LMCA from pulmonary artery known as ALCAPA (anomalous origin of the LCA from the pulmonary artery)
- very rare (1 in 300,000 births); high morbidity and mortality in first 12 months of life
origin of LMCA from right coronary sinus (see Case 1) or non-coronary sinus

See main article: congenital coronary artery anomalies.

References

Anatomy: Thoracic

thoracic skeleton
- thoracic cage
  - ribs
    - typical ribs
    - atypical ribs
    - variant anatomy
      - bifid ribs
      - Srb anomaly
  - costal cartilage
  - sternum
- thoracic spine
- articulations
muscles of the thorax
spaces of the thorax
thoracic viscera
blood supply of the thorax
- arteries
  - thoracic aorta (development)
  - pulmonary trunk
    - left pulmonary artery
      - aberrant left pulmonary artery
    - right pulmonary artery
- veins
  - superior vena cava (cavoatrial junction)
  - inferior vena cava
  - coronary veins
    - cardiac veins which drain into the coronary sinus
      - great cardiac vein
      - middle cardiac vein
      - small cardiac vein
      - posterior vein of the left ventricle
      - vein of Marshall (oblique vein of the left atrium)
    - anterior cardiac veins
    - venae cordis minimae (smallest cardiac veins or thebesian veins)
  - pulmonary veins
    - bronchial veins
lymphatics
innervation of the thorax

Article information

rID: 22844

System: Vascular, Cardiac

Section: Anatomy

Tag: coronary, cases, refs

Synonyms or Alternate Spellings:

Left main coronary artery
LCA
LMCA

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Cases and figures

Figure 1: origin of coronary arteries Figure 1: origin of coronary arteries

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Case 1: anomalous origin and course LCACase 1: anomalous origin and course LCA

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Case 2: anomalous septal LADCase 2: anomalous septal LAD

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Case3: left dominant circulationCase3: left dominant circulation

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