This opened left ventricular outflow tract reveals the aortic valve and the coronary artery orifices. The aortic cusps as depicted from left to right in the photo are left anterior, right anterior, and noncoronary (posterior). Both coronary arteries take their origin from the sinus of Valsalva associated with the left anterior cusp. The right coronary artery, the orifice of which is to the right in the photo, took off at a sharp angle and then coursed between the aorta and the pulmonary trunk. In this anatomical arrangement blood flow can be markedly diminished. The normal site of origin of the right coronary artery is from the sinus of Valsalva associated with the right anterior cusp from which it can easily follow its normal course in the AV groove to the posterior aspect of the heart without sharp twists or turns or being squeezed between the pulsating aorta and pulmonary trunk.
Contributed by Dr. Thomas Gilson
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