PATTERN OF CORONARY ARTERIAL DISTRIBUTION AND ITS RELATION TO CORONARY ARTERY DIAMETER
AbstractBackground: This study was carried out to determine the pattern of coronary arterial distribution and its relation with coronary artery diameter in adult Pakistani population as demonstrated by selective coronary angiography. Methods: Consecutive series of 220 adult subjects who underwent diagnostic coronary angiography at National Institute of Cardiovascular Disease (NICVD) between May 2000 and December 2000 were studied. Patients whose age was more than 18 years, with no apparent disease in the proximal arterial segment, proximal artery and tip of the catheter in the middle of the frame and catheter of a No. 6 French size of same manufacturer used were included in this study. Patients who were given vasodilator before or during the procedure, angiograms showing complete proximal occlusions or ectatic arteries were excluded. Results: Sixty percent subjects had right dominance pattern of which 78.1% were male and 21.8% female. By contrast 15% had left coronary dominance, of which 78.7 % were male and 21.2% female. Where as, 24% patients had co-dominant (balanced) circulation with 83.3 % male and 16.6 % female. In patients with left dominant pattern, the mean diameter of the right coronary artery (RCA) was significantly smaller (p<0.001) as compared to dominant right or co-dominant pattern. Where as in patients with right dominant pattern, the mean diameter of the circumflex (CX) artery was significantly smaller (p<0.001) as compared to dominant left. Conclusion: The coronary arterial distribution in Pakistani population is not significantly different from that given in the literature and the diameter of the RCA and the CX artery are significantly affected by dominance pattern.Key words. Coronary anatomy, dominant pattern, diameter, angiography, Pakistani population.
Sones FM Jr, Shirey EK: Cine coronary arteriography. Mod Concepts Cardiovasc Dis 1962; 33:735-8.
Schlesinger MI. Relation of anatomic pattern to pathologic condition of the coronary arteries. Arch Pathol 1940;30:403-15.
James TN. Anatomy of the Coronary Arteries. New York, Paul B. Hoeber, 1961.
Chuadhry MS. Some observation on the coronary artery pattern and inter-coronary anastomoses in human hearts.Medicus 1965;30:160-72.
The National Heart, Lung, and Blood Institute coronary artery surgery study (CASS). Circulation 1981;63 Suppl I:15-6.
Bergman RA, Thompson SA, Afifi AK, Saadeh FA. Compendium of Human Anatomic Variation: Text, Atlas and World Literature, Baltimore, 1988.
Robert A, Giorgio Gabella, Dussek J, editors. Cardiovascular system: In: Gray’s Anatomy. 38th ed. Great Britain: Churchill Livingstone;1995.p.1510.
Murphy ES, Rosch J, Rahimtoola SH. Frequency and significance of coronary arterial dominance in isolated aortic stenosis. Am J Cardiol 1977 ;39(4):505-9.
Utchins GM, Nazarian IH, Bulkley BH. Association of left dominant coronary arterial system with congenital bicuspid aortic valve. Am J Cardiol 1978; 42(1):57-9.
Ilia R, Rosenshtein G, Weinstein J, Cafri C, Abu-Ful A, Gueron M. Left anterior descending artery length in left and right coronary artery dominance. Coron Artery Dis 2001; 12(1):77-8.
Balci B, Yilmaz O. Atherosclerotic involvement in patients with left or right dominant coronary circulation. Kardiol Pol 2004; 60(6):564-6.
Judkins MP. Selective coronary arteriography I. A percutaneous transfemoral technique. Radiology 1967; 89: 815-24.
Mac Alpin RN, Abbasi AS, Grollman JH, Eber L. Human coronary artery size during life. Diagn Radiol 1972; 108:567-76.
Vasko JS, Gutelius J. Sabiton DC. A study of predominance of human coronary arteries determined by arteriographic and perfusion techniques. Am J Cardiol 1961; 8:374–84.
Franch RH, Doughlas JS Jr, King SB III. Cardiac catheterization and coronary arteriography. In: Fuster V,editor. Hurt's The Heart .10th ed. McGraw-hill 2001.p.562-63.
Kronzon I, Deutsch P, Glassman E. Length of the Left Main Coronary Artery: Its Relation to the Pattern of Coronary Arterial Distribution. Am J Cardiol 1974; 34:787 –9.
Sinnatamby CS, editor. Middle mediastinum and heart. In: Last’s Anatomy Regional and Applied.10th ed. New York: Churchill Livingstone; 1999.p.197-198.
Gross L, Kugel MA. The arterial blood vascular distribution to the left and right ventricles of the human heart. Am H J 1933; 9:265-277.
Dodge JT, Brown BG, Bolson, EL, Dodge HT. Lumen diameter of normal lumen coronary arteries: Influence of Age, Sex, Anatomic Variation, and Left Ventricular Hypertrophy or Dilation. Circulation 1992; 86:232-246.
Pepine CJ. Coronary angiography and cardiac catheterization. In: Topol EJ, editor. Topol Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders Company;1998.p.710-11.