Coronary artery anatomy and morphology in the presence of superdominant right coronary artery

Year 2017, Volume: 50 Issue: 3, 149 - 155, 01.12.2017

Hatice Tolunay

Abstract

Abstaract

Objective: Having
detailed information about normal coronary anatomy and its different variations
provides great advantage in determining the technique to be used during
percutaneous revascularization or operation. There are a lot of studies related
to the coronary artery dominance in the literature, very little data related to
the superdominant right coronary artery (RCA) is available. In this study, we
aimed to describe anatomical features and the diameters of the coronary
arteries in the presence of superdominant RCA.

Method and findings: We evaluated 3454 coronary angiographies retrospectively, which were
implemented in our hospital according to the diagnoses with recognized or
suspicious coronary artery disease (CAD) between 2004 December and 2012
January. The cases in which the left ventricular apex is supplied by posterior
descending artery (PDA) that is a branch of the right coronary artery has been
deemed as superdominant right coronary artery. In 312 (9%) of 3454 patients
whose angiographies had been examined, the right coronary artery was determined
as superdominant. Coronary angiographies of the 312 patients whose right
coronary arteries are superdominant have been evaluated. Coronary artery
diameters and left main coronary artery (LMCA) lengths of the 100 patients
having superdominant right coronary and showing normal coronaries in coronary
angiography have been measured.

Right coronary artery proximal, mid
and distal diameters were measured approximately 4.45±0.93, 4.20±0.99 and
3.50±0.80, respectively. Diameter of LMCA was measured approximately 4.72±0.88,
4.70±0.89 and 4.72±0.88 mm in proximal, mid and distal, respectively and
average LMCA length was measured 12.05±3.67 mm. Average LAD diameter was
measured 3.64±0.67, 3.01±0.72 and 2.07±0.34 in the proximal, the mid and the
distal, respectively and the average circumflex artery (CXA) diameter was
measured 2.92±0.66 and 1.88±0.41 in the proximal and the distal, respectively.

The correlation between LMCA
proximal diameter and RCA proximal diameter was found as significantly
meaningful.  Also, it was determined that
the difference between the averages of the LAD and RCA tapering indexes had
been statistically significant.

Conclusion:
RCA proximal and distal segment diameters in the presence of the super-dominant
right coronary artery are significantly larger compared to LAD and CX
diameters. Antegrade tapering is not sufficient for RCA. The length of the LMCA
has increased compared to the previous study data. As expected, LAD artery is
underdeveloped in these cases, terminates before reaching to the apex and
equally terminates in the distal with a diagonal artery that is developed
frequently in the mid region. Antegrade tapering is distinct for LAD artery. In
these patients, intermediate artery frequency is over the conventional rates
and myocardial bridge association is lower. Sinoatrial node artery and conus
branch take their origins from the right coronary artery over the conventional
values. 

Keywords

Superdominant right coronary artery;, coronary anatomy, coronary dominance

Coronary artery anatomy and morphology in the presence of superdominant right coronary artery

Abstract

Özet

Amaç:İskemik kalp hastalığı ile başvuran
hastalarda perkütan revaskülarizasyon veya operasyon sırasında kullanılacak
tekniğin saptanması amacıyla normal koroner anatominin ve çeşitli
varyasyonların ayrıntılı bilinmesinin yararı büyüktür. Koroner arter dominansı
ile ilgili literatürde çok sayıda çalışma var, süperdominant sağ koroner arter
ile ilgili çok az veri mevcut. Biz bu çalışmada süperdominant sağ koroner arteri
(RCA) olan  vakaların koroner arter
çaplarını ve anatomik özelliklerini tanımlanmayı amaçladık.

Yöntem ve bulgular: Hastanemizde Aralık
2004 ve Ocak 2012 tarihleri arasında bilinen ya da şüpheli koroner arter
hastalığı (KAH) tanıları ile yapılan 3454 koroner anjiyografi retrospektif
olarak değerlendirildi. Sol ventrikül apeksinin, sağ koroner arterin dalı olan
posterior descending arter (PDA) tarafınca beslendiği vakalar süperdominant sağ
koroner arter olarak kabul edildi. Anjiyografisi incelenen 3454 hastanın
312’sinde (%9) sağ koroner arter süperdominant olarak saptandı. Sağ koroner
arteri süperdominant olan 312 hastanın koroner anjiyografileri (KAG)
değerlendirildi. Süperdominant sağ koroneri olan ve
koroner anjiyografide normal koronerler saptanan 100 hastanın koroner
arter çapları ve sol ana koroner arter (LMCA) uzunlukları ölçüldü.

Sağ koroner
arter proksimal, mid, distal çapları ortalama 4.45±0,93, 4.20±0,99, 3.50±0,80
mm ölçüldü. LMCA çapı proksimal, mid ve distalde ortalama 4.72±0,88, 4,70±0,89,
4,72±0,88 mm ve ortalama LMCA uzunluğu 12,05±3,67 mm idi.  Ortalama LAD çapı proksimal, mid ve distalde
3.64±0,67, 3.01±0,72, 2.07±0,34 mm olup, sirkümflex arter (CX) ortalama
proksimal ve distal çapı  2.92±0,66 ve
1,88±0,41 mm idi.

LMCA proksimal
çapı ile RCA proksimal çapı arasındaki ilişki istatistiksel olarak anlamlı
bulundu. LAD ve RCA tapering indekslerinin ortalamaları arasındaki farkın istatistiksel
olarak anlamlı olduğu belirlendi.

 Sonuç:
Süperdominant sağ koroner arter varlığında RCA proksimal ve distal segment
çapları, LAD ve CX çapları ile karşılaştırıldığında anlamlı olarak RCA’nın daha
geniştir. RCA için antegrade tapering yetersizdir. LMCA uzunluğu daha önceki
çalışma verilerine göre artmıştır. LAD arter beklenildiği üzere bu vakalarda az
gelişmiş olup apekse ulaşmadan sonlanmakta ve sıklıkla mid bölgede gelişmiş bir
diagonal arterle distalde eşit sonlanmaktadır. LAD arter için antegrade
tapering belirgindir. Bu hastalarda intermediate arter sıklığı bilinen
oranların üzerinde olup myokardiyal bridge birlikteliği düşüktür. Sinoatriyal
nod arter ve konus dalı bilinen değerlerin daha üzerinde sağ koroner arterden
köken almaktadır.

Keywords

Süperdominant sağ koroner arter, koroner arter anatomi, koroner dominans

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