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

Yıl 2017, Cilt: 50 Sayı: 3, 149 - 155, 01.12.2017

Hatice Tolunay

Öz

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. 

Anahtar Kelimeler

Superdominant right coronary artery;, coronary anatomy, coronary dominance

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

Öz

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.

Anahtar Kelimeler

Süperdominant sağ koroner arter, koroner arter anatomi, koroner dominans

Kaynakça

• REFERENCES 1. Schlesinger MJ. Relation of anatomic pattern to pathologic conditions of coronary arteries. Arch Path, 1940;30:403-415.
• 2. Perlmutt LM, Jay ME, Levin DC. Variations in the blood supply of the left ventricular apex. Invest Radiol 1983;18:138-40.
• 3. Baroldi G, Scomazzoni G. Coronary circulation in the normal and pathologic heart. Washington D.C.Office of the surgeon General 1967:11
• 4. Nerantzis CE, Papachristos JC, Gribizi JE, Voudris VA. Functional dominance of the right coronary artery : incidence in the human heart Clin. Anat.1996;9:10-3.
• 5. Gazetopoulos N, Ioannidis PJ, Karydis C, Lolas C, Kiriakou K, Tountas C. Short left coronary artery trunk as a risk factor in the development of coronary atherosclerosis. Pathological study. Br Heart J. 1976; 38: 1160–1165.
• 6.Gazetopoulos N, Ioannidis PJ, Marselos A, Kelekis D, Lolas C, Avgoustakis D, Tountas C. Lenght of main left coronary artery in relation to atherosclerosis of its branches. A coronary arteriographic study. Br Heart J 1976;38:180-185.
• 7. Kronzon I, Deutsch P, Glassman E. Length of the left main coronary artery: Its relation to the pattern of coronary arterial distribution American Journal of Cardiology 1974;34:787-789.
• 8. Zeina AR, Rosenschein U, Barmeir E. Dimensions and anatomic variations of left main coronary artery in normal population: multidetector computed tomography assessment. Coron Artery Dis. 2007;18:477-82.
• 9. Dewey M, Kroft LJM. Anatomy. In: Dewey M, ed. Coronary CT angiography. Berlin: Springer, 2009;11–26.
• 10. DiDio LJ, Lopes AC, Caetano AC, Prates JC. Variations of the origin of the artery of the sinoatrial node in normal human hearts. Surg Radiol Anat 1995;17:19-26 11. Koşar P, Ergun E, Oztürk C, Koşar U. Anatomic variations and anomalies of the coronary arteries: 64-slice CT angiographic appearance. Diagnostic and interventional radiology Ankara Turkey 2009;15: 275-283
• 12. Zeina AR, Rosenschein U, Barmeir E. Dimensions and anatomic variations of left main coronary artery in normal population: multidetector computed tomography assessment Coronary Artery Disease: 2007;18:477-482.
• 13. Fox C, Davies MJ, Webb-Peploe MM. Length of left main coronary artery. Br Heart J. 1973; 35: 796-798.
• 14. Mancini GB, Ryomoto A, Kamimura C, Yeoh E, Ramanathan K, Schulzer M, Hamburger J, Ricci D. Redefining the normal angiogram using population-derived ranges for coronary size and shape: validation using intravascular ultrasound and applications in diverse patient cohorts Int J Cardiovasc Imaging 2007;23:441-453.
• 15. Nowak D, Gielecki J, Zurada A, Góralczyk K. No relationship between the length of the left coronary artery main stem and the type of coronaryvasculature in human fetuses from a morphological perspective. Med Sci Monit. 2009;15:CR20-5.
• 16. Virmani R, Chun PK, Robinowitz M, Goldstein RE, McAllister HA Jr. Length of left main coronary artery. Lack of correlation to coronary artery dominance and bicuspid aortic valve: an autopsy study of 54 cases. Arch Pathol Lab Med. 1984;108:638-41
• 17. Kim PJ, Hur G, Kim SY, Namgung J, Hong SW, Kim YH, Lee WR. Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: A comparison between computed tomography and invasive coronary angiography. Circulation 2009;119:1408-1416
• 18. Rossi L, Dander B, Nidasio GP, Arbustini E, Paris B, Vassanelli C, Buonanno C, Poppi A. Myocardial bridges and ischemic heart disease. Eur Heart J.1980;1:239-245.
• 19. Erol C, Seker M. The prevelance of coronary artery variations on coronary computed tomography angiography. Acta Radiol. 2012;53:278-84.
• 20. Zubaid M, Buller C, Mancini GB. Normal angiographic tapering of the coronary arteries. Can J Cardiol. 2002;18:973-80.
• 21. Ilia R, Rosenshtein G, Weinstein J, Cafri C, Abu-Ful A, Gueron M. Left anterior descending artery lenght in left and right coronary artery dominance. Coronary artery disease 2001;12:77-78.
• 22. Christensen KN, Harris SR, Froemming AT, Brinjikji W, Araoz P, Asirvatham SJ, Lachman N. Anatomic assessment of the bifurcation of the left main coronary artery using multidetector computed tomography. Surgical and Radiologic Anatomy. 2010;32:903-909.