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Fig. 2D —Terminal anatomic course of S-shaped sinoatrial node (SAN) artery. 85-year-old man with retrocaval (A and B) and 61-year-old woman with precaval (C and D) mode of termination of artery. Sculptured 3D CT images (A and C) and corresponding axial images (B and D) at level of superior cavoatrial junction show S-shaped SAN arteries (short arrows, A and C). Proximal courses of artery are similar in most cases. Arising from proximal left circumflex artery, S-shaped SAN artery turns posteriorly and courses in groove between left atrial appendage (LAA) and left superior pulmonary vein (LSPV) orifices (short arrows, B and D). We found that in most cases distal artery coursed close to interatrial groove, penetrated interatrial muscle bundle, and followed its course behind superior vena cava (SVC) (retrocaval) to reach SAN area on lateral aspect of cavoatrial junction (long arrows, A and B). This variant is prone to injury in superior septal approach to mitral valve repair. In precaval mode of termination (long arrows, C and D), artery courses away from interatrial groove to reach anterior margin of superior cavoatrial junction and is less susceptible to injury. AA = ascending aorta, RSPV = right superior pulmonary vein.