Soft-tissue considerations in esthetic reconstruction

We describe herein a rare and hitherto not reported variation, found in a Japanese male cadaver, in which a posterior sinus node (SN) artery and an accessory atrioventricular node (AN) artery originate from a common trunk branching from the posterior segment of the circumflex artery. After arising in this manner, the posterior SN artery passed in a clockwise direction around the posterior, lateral, and finally anterior wall of the left atrium to the sinus venosus, giving off a branch to the SN from posteriorly. The accessory AN artery coursed in a counterclockwise direction on the posterior wall of the left atrium as far as the crux of the heart, where it bent anterosuperiorly and continued within the interatrial septum. It entered the AN from superiorly and, crossing deep to the principal AN artery, reached the inferior and superficial portion of this node. It could be considered that the accessory AN artery in this study is a modified version of arteries entering and coursing in the interatrial septum, as exemplified by Kugel's anastomotic artery.