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The anatomy and development of normal and abnormal coronary arteries*

Published online by Cambridge University Press:  16 December 2015

Diane E. Spicer
Department of Pediatric Cardiology, University of Florida, Gainesville, Florida, United States of America Congenital Heart Institute of Florida, St Petersburg, Florida, United States of America
Deborah J. Henderson
Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Bill Chaudhry
Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Timothy J. Mohun
Division of Developmental Biology, MRC National Institute for Medical Research, London, United Kingdom
Robert H. Anderson*
Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom Division of Biomedical Sciences, St George’s University of London, London, United Kingdom
Correspondence to: Professor R. H. Anderson, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel: +44 20 8870 4368; E-mail:


At present, there is significant interest in the morphology of the coronary arteries, not least due to the increasingly well-recognised association between anomalous origin of the arteries and sudden cardiac death. Much has also been learnt over the last decade regarding the embryology of the arteries. In this review, therefore, we provide a brief introduction into the recent findings regarding their development. In particular, we emphasise that new evidence, derived using the developing murine heart, points to the arterial stems growing out from the adjacent sinuses of the aortic root, rather than the arteries growing in, as is currently assumed. As we show, the concept of outgrowth provides an excellent explanation for several of the abnormal arrangements encountered in the clinical setting. Before summarising these abnormal features, we draw attention to the need to describe the heart in an attitudinally appropriate manner, following the basic rule of human anatomy, rather than describing the cardiac components with the heart in the “Valentine” orientation. We then show how the major abnormalities involving the coronary arteries in humans can be summarised in terms of abnormal origin from the pulmonary circulation, abnormal aortic origin, or fistulous communications between the coronary arteries and the cardiac cavities. In the case of abnormal aortic origin, we highlight those malformations known to be associated with sudden cardiac death.

Original Articles
© Cambridge University Press 2015 

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Presented at the Johns Hopkins All Children’s Heart Institute 15th Annual International Symposium on Congenital Heart Disease, Saint Petersburg, Florida, United States of America, from Friday, 6 February, 2015 to Monday, 9 February, 2015.


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