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

Background: The right coronary artery (RCA) exhibits significant anatomical variability in its branching pattern, which critically influences coronary interventions, surgical revascularization, and diagnostic imaging. Despite its clinical relevance, detailed data on RCA variations in South Asian populations remain limited. 
Objective: To evaluate the anatomical variations in the branching pattern of the RCA using combined cadaveric dissection and angiographic analysis in a Bangladeshi cohort. 
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. Parameters assessed included ostial morphology, branching patterns, termination points, vessel dominance, and other anatomical variations (e.g., myocardial bridging, extramural anastomoses). Data were analyzed using SPSS v16.0, with statistical significance set at *p* < 0.05. 
Results: The study revealed the RCA originated from the anterior aortic sinus in 98.3% of cases, with a rare anomalous origin (1.7%) from the left posterior sinus. Ostial variations showed single (65%), double (28.3%), and triple (5%) openings, mostly circular (53.3%) or oval (30%), averaging 2.07 ± 0.46 mm diameter. Most RCAs terminated between the crux and obtuse margin (76.7%). Branching patterns included 2-8 anterior right ventricular branches (proximal segment) with frequent right conus artery presence (66.7%). The sinoatrial nodal artery originated from RCA in 56.7% of cases. Right dominance predominated (90%), while myocardial bridging was uncommon (3.3%). Significant RCA-LAD anastomoses occurred in 30% of specimens. 
Conclusion: This study highlights significant RCA variations in a Bangladeshi population, including frequent right dominance (90%) and variable branching patterns. These findings emphasize the importance of anatomical awareness in clinical and interventional cardiology, particularly in settings with limited access to advanced imaging.