Coronary arteriograms of 418 adult patients were studied to ascertain the frequency of variations in blood supply of the anterolateral free wall of the left ventricle; 92.6% had from one to three ramus medianus or diagonal branches supplying this area. Complete absence of any ramus medianus or diagonal branches was exceedingly rare (only 0.5% in this series), and when this occurs the angiographer should suspect complete occlusion of one or more such branches immediately at their origins. Failure to detect ostial occlusion of a ramus medianus or diagonal branch may be a cause of significant misinterpretation of coronary arteriograms.