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

ÖzetAmaç: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

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

AbstaractObjective: 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,

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