Missing coronary artery. Review of technical problems in coronary arteriography resulting from anatomical variants.

Coronary arteriography is routinely used as a diagnostic measure or as a prelude to surgical treatment. Failure to visualise a coronary artery division is relatively frequent and generally attributable to a complete proximal occlusion, even if no stump of blocked artery is demonstrated. Failure to intubate a coronary artery is usually the result of inadequate technique. Both of these failures may be caused by congenital variants of anatomy with which the investigator should be familiar. In this paper we survey and illustrate the congenital variations of the coronary arteries which were documented in 75 out of 8235 patients without associated congenital heart disease, discuss their incidence in the routine investigation of patients with suspected ischaemic heart disease, and suggest a methodical approach to their recognition.