Vol. 7, Issue 2, Part A (2025)

Background: The right coronary artery (RCA) exhibits significant anatomical variability in its course and termination, which critically influences percutaneous coronary interventions, surgical revascularization, and congenital heart disease management. Despite its clinical importance, comprehensive data on RCA termination patterns in South Asian populations remain limited. Objective: To evaluate the anatomical variations in the course and termination of the RCA. Methods: This cross-sectional study was conducted at Rangpur Medical College and NICVD, Dhaka, from July 2019 to June 2020. Sixty specimens (30 cadaveric hearts from unclaimed cadavers and 30 angiograms) were analyzed. Termination points, branching patterns, dominance, and variations were assessed. Data were analyzed using SPSS v16.0, with statistical significance at p<0.05. Results: The RCA originated from the anterior aortic sinus in 98.3% of cases, with one variant (1.7%) arising from the left posterior sinus. Termination occurred between the crux and obtuse margin in 76.7% of cases, at the crux in 10%, and at the acute margin in 3.3%. Myocardial bridges were observed in 3.3% of RCAs. The RCA supplied the posterior interventricular artery (PIVA) in 90% of cases (right-dominant circulation). Angiographically, the RCA exhibited a characteristic "C-shaped" course in the left anterior oblique view. Conclusion: This study delineates the RCA’s termination patterns and anatomical variations in a Bangladeshi population, highlighting high right-dominance prevalence (90%) and rare anomalous origins (1.7%). These findings underscore the importance of preoperative anatomical mapping for coronary interventions and surgical planning, particularly in resource-limited settings where advanced imaging may be unavailable.