Letter to the Editor

Fibonacci Series and Coronary Anatomy
Keywords. Fibonacci; Coronary; Anatomy; Morphology; Phyllotaxis; Biomathematics


he thirteenth century mathematician, Leonardo of Pisa, nicknamed “Fibonacci” described a sophisticated number series that was subsequently named after him. The sequence follows 2, 3, 5, 8, 13, 21, 34, 55, 89, etc. and represents a trend observable in many natural settings. These include inheritance patterns, the design of flowers and the branching of leaves (phyllotaxis) [1]. Its widespread existence is further signified by its ability to derive the ‘Golden Ratio’ also known as ‘nature’s mathematical holy grail’. This ratio of approximately 1.61 is consistently seen not only in biology, but also in works of great art and architecture. We hypothesise that the structure of the coronary arterial tree can be considered analogous to the leaf branching seen in trees, and it has previously been reported [2] that diseased atherosclerotic lesions in coronary arteries follow a Fibonacci distribution. We further propose that the distribution of coronary arteries themselves can reveal a morphological spread that follows a Fibonacci series of 2, 3, 5, 8, and 13 (Fig. 1, Table 1). The arteries are distributed sequentially to closely resemble phyllotaxis seen elsewhere in nature, but also reveal an underlying association with the ‘Golden Ratio’. Studying data from 36 mammalian species, from mouse to giraffe [3], one can calculate that the association of cardiac diameters divided by the sum diameters of all 13 branches across these species is in the order of the golden ratio’s 1.61. Fibonacci number theory can be used to develop innovative bio-mathematical models of the coronary system

Figure 1. Anatomical branching of the coronary arterial tree corresponding to the Fibonacci series (authors’ interpretation).

Table 1. Sequence branching of the coronary arterial tree. LCA = Left Coronary Artery, RCA = Right Coronary Artery, LAD = Left Anterior Descending, LCX = Left Circumflex, OM = Obtuse Marginal, AM = Acute Marginal, PDA = Posterior Descending Artery, LDiag = Left Diagonal, RDiag = Left Diagonal, PLV = Posterior Left Ventricular (1) = lateral; (2) = intermediate; (3) = medial, PRV = Posterior Right Ventricular (1) = lateral; (2) = intermediate; (3) = medial, Sep = Septal, RI = Ramus Intermedius (authors’ interpretation).
Number of branches 2 3 5 8 13 LCA LAD LAD LAD LAD RCA LCx LCx LDiag1 PLV1 RCA RI LCx PRV1

AM OM1 Sep3

PDA Sep1 Sep4


Rdiag1 LDiag2

AM Sep2






© 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.

1443-9506/04/$36.00 doi:10.1016/j.hlc.2011.02.008



Ashrafian and Athanasiou Fibonacci Series and Coronary Anatomy

Heart, Lung and Circulation 2011;20:483–484

and its associated cardiovascular apparatus to enhance the depiction of myocardial metabolic maps and predict disease location and geometry. Examples include its use in radionuclide myocardial perfusion imaging (rMPI), fluorodeoxyglucose positron emission tomography (FDGPET), iodine-123 meta-iodobenzylguanidine (123 I-MIBG) scintigraphy, single photon emission computed tomography (SPECT), positron emission tomography (PET) with novel tracers, computed tomography (CT), magnetic resonance imaging (MRI), cardiac nuclear magnetic resonance (NMR) and ground-breaking imaging modalites yet to be developed. Applying the Fibonacci series to our current understanding of coronary development can therefore increase our comprehension of the mechanisms of coronary vascular branching and may also contribute to the development of new techniques of cardiac arterial imaging.

Hutan Ashrafian, MRCS ∗ Thanos Athanasiou, FETCS The Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM-Building, Praed Street, London W2 1NY, UK Corresponding author. Tel.: +44 0 20 33127651; fax: +44 0 20 3312 6309. E-mail address: h.ashrafian@imperial.ac.uk (H. Ashrafian) Available online 13 April 2011

[1] Mitchison GJ. Phyllotaxis and the Fibonacci Series. Science 1977;196:270–5. [2] Gibson CM, Gibson WJ, Murphy SA, Marble SJ, McCabe CH, Turakhia MP, et al. Association of the Fibonacci Cascade with the distribution of coronary artery lesions responsible for ST-segment elevation myocardial infarction. Am J Cardiol 2003;92:595–7. [3] Thüroff JW, Hort W, Lichti H. Diameter of coronary arteries in 36 species of mammalian from mouse to giraffe. Basic Res Cardiol 1984;79:199–206.

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