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Posterior right diagonal artery
C E Nerantzis1, J E Gribizi, N G Margaris
1Pathology Department, University of Athens, Greece.
Insights
A newly identified posterior right diagonal artery (PRDA) clarifies anatomical confusion. This vessel, originating from the right coronary artery, has significant implications for interpreting coronary arteriograms and guiding cardiac surgery.
Area of Science:
- Cardiovascular Anatomy
- Coronary Artery Anatomy
Background:
- Existing confusion surrounds a specific right coronary artery branch, with varied nomenclature including "lower trunk," "posterior reflection of the right marginal artery," "ramus lateralis," and "posterolateral branch."
- This anatomical ambiguity necessitates clearer definition for clinical applications.
Purpose of the Study:
- To define and characterize a distinct branch of the right coronary artery.
- To establish consistent terminology for this vessel and clarify its anatomical course and variations.
Main Methods:
- Direct observation of 300 human hearts.
- Analysis of X-ray films and corrosion casts for detailed anatomical assessment.
Main Results:
- A branch, termed the posterior right diagonal artery (PRDA), was identified originating from the right coronary artery (RCA).
- The PRDA arises after the right marginal artery (RMA) in 84% of cases or continues it in 16%.
- Its prevalence varied with right dominance and posterior descending artery (PDA) length, serving as a potential bridge between RCA and left anterior descending artery.
Conclusions:
- The findings provide a precise anatomical definition for the PRDA, resolving previous nomenclature confusion.
- Accurate interpretation of coronary arteriographies and improved outcomes in coronary artery surgery are anticipated.
- This anatomical clarification is crucial for interventional cardiology and surgical planning.
Background:
There is general confusion about a branch of the posterior segment of the right coronary artery that has been referred to as 1) the lower trunk of a divided right coronary artery; 2) a posterior reflection of the right marginal artery; 3) the ramus lateralis; and 4) a posterolateral branch or a posterior descending artery.
Materials:
Three hundred human hearts were studied by direct observation, X-ray films, and corrosion casting.
Results:
This branch of the right coronary artery arises either after the right marginal artery (in 84% of hearts) or it constitutes the continuation of this artery in the remaining 16%. We named it the posterior right diagonal artery (PRDA). It was found in 14% of 266 hearts of right dominant type. It was present in 39% when the length of the posterior descending artery (PDA) was shorter than half of the length of the posterior interventricular sulcus (PIS) and in 6% when it was longer. When the PRDA originated directly from the RCA, the RMA appeared underdeveloped; the PRDA always occupied the inferior part of the PIS and appears either as continuation of a short PDA or as a replacement for a long PDA from the point where this artery leaves the PIS to enter the posterior wall of the left ventricle. The PDRA when present serves as a bridge between the RCA and the left anterior descending artery.
Conclusions:
These findings are of practical importance for the correct interpretation of coronary arteriographies and in the field of coronary artery surgery.