This is the name given to a particular anatomical variation of the bifurcation of the left coronary artery (LMCA). Normally the LMCA bifurcates giving origin to the circumflex artery (CFX) and the anterior interventricular artery, also known as the left anterior descending artery (LAD).
In the case of the “ramus intermedius” variation, the LCMA trifurcates, that is, forks into three branches: an LAD, a CFX and an intermediate branch that provides blood supply to the anterolateral aspect of the left ventricular surface and/or the obtuse margin of the heart. The ramus intermedius may take one of two directions. It may behave like a diagonal branch (D1, D2) of the LAD or as an obtuse marginal artery (OM1).
The ramus intermedius anatomical variation is quite common and literature states that it may be present in 20-33% of the cases. One of my pet peeves (see my top pet peeve here) is that most medical industry providers as well as many surgeons and physicians call this anatomical variation a “ramus”. You see, the Latin term [ramus] means “branch” and by itself is not descriptive. The proper name is the Latin term “ramus intermedius” which means “the intermediate branch”.
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Image property of: CAA.Inc. Photography: Efrain Klein
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