Terminal branching pattern of the right coronary artery in left-dominant hearts: a cadaveric study
Tulika Gupta1, Abhimanyu Saini, Daisy Sahni
1Department of Anatomy, Postgraduate Institute of Medical Education & Research, sector-12, Chandigarh-160012, India. tulikag11@yahoo.com
Insights
In left-coronary-dominant hearts, the right coronary artery (RCA) inconsistently supplies the right ventricle's posterior surface. This variability may explain increased mortality during left coronary artery ischemia.
Area of Science:
- Anatomical studies
- Cardiovascular research
- Human anatomy
Background:
- Left coronary dominance is linked to higher mortality and severity in left coronary artery myocardial ischemia.
- Understanding right coronary artery (RCA) variations in left-dominant hearts is crucial for assessing posterior right ventricular blood supply.
Purpose of the Study:
- To objectively document the termination and branching patterns of the RCA in left-coronary-dominant human hearts.
- To investigate the RCA's contribution to the posterior right ventricular surface blood supply in these hearts.
Main Methods:
- Seventy-five human cadaveric hearts were analyzed.
- Coronary vessels were injected with colored cellulose acetate butyrate and dissected.
- Coronary dominance was determined, with a focus on left-dominant specimens.
Main Results:
- Left coronary dominance was observed in 13% of the specimens.
- The RCA's posterior ventricular branches were variable in number (0-5) and length (5-15 mm).
- The acute marginal artery occasionally lacked posterior ventricular branches, and the atrial branch was present in 50% of hearts.
Conclusions:
- The RCA is an inconstant and unreliable source for posterior right ventricular perfusion in individuals with left-coronary-dominant hearts.
- This anatomical variability may contribute to increased morbidity and mortality during left coronary artery ischemia.
Background:
Left coronary dominance has been reported to be associated with increased mortality and severity in case of myocardial ischemia involving left coronary artery. The present cadaveric study was proposed to objectively study and document the termination and branching pattern of the right coronary artery in left-coronary-dominant hearts in relation to the blood supply to the posterior surface of the right ventricle.
Methods:
Seventy-five cadaveric hearts were studied. The coronary vessels were injected with colored cellulose acetate butyrate and dissected. The coronary dominance was determined. In left-dominant hearts, branches and termination of the right coronary artery were studied.
Results:
Left coronary dominance was found in 13% of the specimens. The number of ventricular branches was found to be present as 0, 1, 2, and 4 in two, four, two, and two of the cases, respectively. The average length of the ventricular branch was 12.7 mm with a range of 5-35 mm. The atrial branch was found in 50% of hearts, varying from 2 to 3 mm in length. In three hearts, the acute marginal artery did not give any posterior ventricular branch, while two, three, and five posterior ventricular branches were seen in four, two, and one heart(s), respectively. The length of the posterior ventricular arteries was between 5 and 15 mm.
Conclusion:
The RCA is an inconstant and unreliable source of posterior right ventricular perfusion in a significant percentage of population with left-coronary-dominant hearts. This might be the reason for the increased morbidity and mortality seen in the event of left coronary ischemia.
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