Abstract
Introduction: There is considerable variation in the arterial supply of diaphragmatic surface of the heart. Diaphragmatic myocardial infarction is one of the more common consequences of coronary artery disease. The aim of this study was to assess the incidence of anatomic variants of origin and termination of Posterior Descending Artery (PDA) and to determine the type of coronary dominance in North Indian population. Subjects and Methods: This prospective study was carried out on 50 routine subjects of different age groups who came to the Department of Radiodiagnosis, King George’s Medical University UP, Lucknow in the year 2010- 2011 with known or suspected coronary artery disease. All the cases were investigated on a 64 slice Multidetector Computed Tomographic (MDCT) scanner, using retrospective Electrocardiographic gating. Endeavour was made to determine the incidence of sites of origin and termination of PDA as well as to determine the type of coronary dominance. Results: PDA arose from Right Coronary Artery (RCA) in 39 (78%) cases and from Left Circumflex (LCx) artery in 11(22%) cases. The PDA was found to terminate in the upper 1/4 of Posterior Inter-Ventricular Groove (PIVG) in 18 (36%) cases, in upper 1/2 of PIVG in 19 (38%) cases, in upper 3/4 of PIVG in 10 (20%) cases and at the apex of the heart in 1 (2%) case. None of the female had termination of PDA at the apex. Termination of PDA could not be determined in 2 (4%) cases. Right dominance was seen in 36 (72%) cases, Left dominance in 11 (22%) cases. and Co-dominance in 3 (6%) cases. Conclusion: Posterior descending artery most commonly terminated after traversing the upper half of posterior inter-ventricular groove. The incidence of left coronary dominance was more in females, it was approximately twice the incidence found in males. Co-dominance was observed only in male subjects.
Highlights
There is considerable variation in the arterial supply of diaphragmatic surface of the heart
Posterior Descending Artery (PDA) arises from Right Coronary Artery (RCA) in right dominant and co-dominant hearts, while it arises from Left Circumflex (LCx) artery in left dominant hearts
In approximately 70% individuals, it arises from RCA near the crux of the heart and ends by anastomosing with the Anterior Inter-Ventricular Artery (AIVA) [Left Anterior Descending (LAD) artery] of Left Coronary Artery (LCA)
Summary
There is considerable variation in the arterial supply of diaphragmatic surface of the heart. The aim of this study was to assess the incidence of anatomic variants of origin and termination of Posterior Descending Artery (PDA) and to determine the type of coronary dominance in North Indian population. The artery that supplies the PDA and a posterolateral branch determines the coronary dominance.[1] PDA is known as Posterior Inter-Ventricular Artery (PIVA). Coronary dominance is based on the arterial supply to the diaphragmatic surface of heart by either right or left coronary artery.[2] The dominant coronary artery is that which gives the posterior interventricular branch, traversing the posterior interventricular sulcus and supplying the posterior part of the ventricular septum and often part of the Academia Anatomica International ¦ Volume 4 ¦ Issue 2 ¦ July-December 2018
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