Coronary artery dual ostia

(Redirected from Separate ostia)
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Coronary Angiography


General Principles

Historical Perspective
Appropriate Use Criteria for Revascularization
Film Quality

Anatomy & Projection Angles

Normal Anatomy

Coronary arteries
Right System
Left System
Left Main
Left Anterior Descending
Median Ramus

Anatomic Variants

Separate Ostia
Anomalous Origins
Case Example

Projection Angles

Standard Views
Left Coronary Artery
Right Coronary Artery

Epicardial Flow & Myocardial Perfusion

Epicardial Flow

TIMI Frame Count
TIMI Flow Grade
TIMI Grade 0 Flow
TIMI Grade 1 Flow
TIMI Grade 2 Flow
TIMI Grade 3 Flow
TIMI Grade 4 Flow
Pulsatile Flow

Myocardial Perfusion

TIMI Myocardial Perfusion Grade
TMP Grade 0
TMP Grade 0.5
TMP Grade 1
TMP Grade 2
TMP Grade 3

Lesion Complexity

ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis

Preprocedural Lesion Morphology

Intimal Flap
Sawtooth Pattern
Ostial location
Proximal tortuosity
Degenerated SVG
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
Degenerated SVG

Left ventriculography

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


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.[1]

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


  1. Yamanaka, O.; Hobbs, RE. (1990). "Coronary artery anomalies in 126,595 patients undergoing coronary arteriography". Cathet Cardiovasc Diagn. 21 (1): 28–40. PMID 2208265. Unknown parameter |month= ignored (help)

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