Coronary anatomy: Difference between revisions
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'''Coronary anatomy and imaging planes''' | |||
'''Aortic root''' | |||
'''Coronary arteries''' | |||
The two main coronary trunks lie in two perpendicular planes (Fig 1); The Right Coronary Artery (RCA) and Left Circumflex Artery (LCX) run in the atrioventricular groove. The Left Anterior Descending (LAD) or Ramus Descendens Anterior (RDA) and Right Posterior Descending (RDP) run in the interventricular groove in de plane of the interventricular septum. In the standard Right Anterior Oblique (RAO) 30 we are looking down the plane of the AV-valves and have the LAD and the IVS running form left to right on the screen (Fig 2). In the Left Anterior Oblique 45 (LAO) projection we will be looking directly onto the AV-plane. | |||
[[File:Coronary_anatomy_AHA.svg|thumb|none|500px| Coronary anatomy with AHA classification <cite>AHA</cite>]] | [[File:Coronary_anatomy_AHA.svg|thumb|none|500px| Coronary anatomy with AHA classification <cite>AHA</cite>]] | ||
'''Right Coronary Artery''' | |||
The right coronary artery has its ostium just beneath the Sinotubular junction in the Right Coronary Cusp (RCC). It gives rise to the conus branch which supplies the Right Ventricular Outflow Tract. In about 60% of the cases the SA node is supplied by a proximal branch arising from the RCA (The other 40% via a left atrial branch comming from the RCX). The RCA follows the AV-groove giving rise to one or more Marginal Branches (which supply the RV free wall). Continuing in the AV-groove in the most common anatomical form it gives rise to a right posterior descending (RDP; supplies the inferior septum) artery and a right posterolateral branch (RPL) (Fig 1 and 3). At the junction with the RDP a small side branch supplies the AV-node (AV-nodal artery) | |||
Several anatomical variants are common. Both the PL- and DP-branches can also be sidebranches from the LCX. A left dominant circulation is present when the LCX also supplies the RDP. In a left dominant circulation the right coronary artery is usually small. A balanced system is present when the LCX supplies a parallel descending branch also supplying the inferior septum. Left dominant circulation is seen in about 8% of the patients. | |||
* [[Left Coronary Artery - Right Dominant]] | * [[Left Coronary Artery - Right Dominant]] | ||
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* [[Right Coronary Artery - Right Dominant]] | * [[Right Coronary Artery - Right Dominant]] | ||
* [[Right Coronary Artery - Left Dominant]] | * [[Right Coronary Artery - Left Dominant]] | ||
'''Left Coronary Artery''' | |||
The Left Coronary Artery (LCA) arises from the superior portion of the of the left aortic sinus just below the sinotubular junction. Typically it begins as a Left Main (LMCA) for about 0 to 10mm before giving rise to the LAD and LCX. In less than 1% there is no LMCA and the LAD and LCX originate directly from the left sinus of valsalva; so-called seperate ostia. The left main can also give rise to intermediate or anterolateral (AL) branches that originate from the left main inbetween the LAD and LCX. | |||
'''Left anterior descending''' | |||
The LAD runs on the epicardial surface in the interventricular groove towards the apex. The major branches coming from the LAD are the septal and diagonal branches. The septals pass into the interventricular septum. The diagonals run anterolateral on the epicardial surface. There is a wide variability in both the number and size of septal and diagonal branches. | |||
'''Ramus Circumflex''' | |||
The LCX follows the posterior AV-groove giving rise to obtuse marginal branches supplying the posterolateral wall op the heart. As described before in some cases the LCX also supplies the sinus node via a left atrial branch. In left dominant circulation the circumflex supplies the inferior interventricular septum via a descendens posterior artery. | |||
* [[Left ventriculogram]] | * [[Left ventriculogram]] | ||