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Coronary arterial dominance

Dr Yuranga Weerakkody ◉ and Dr Craig Hacking ◉ ◈ et al.

Coronary arterial dominance is defined by the vessel which gives rise to the posterior descending artery (PDA), which supplies the myocardium of the inferior 1/3^rd of the interventricular septum.

Most hearts (80-85%) are right dominant where the PDA is supplied by the RCA. The remaining 15-20% of hearts are roughly equally divided between left dominant (~10%) and codominant (~20%). The strict definition of codominance can vary depending of which modality one uses to assess the coronary arteries (coronary angiography or CTCA) but is not overly important. Regardless, in left dominant hearts the PDA is supplied by the LCx (circumflex) wrapping around the left atrioventricular groove or less commonly the LAD coursing around the apex of the heart. In a codominant heart a single or duplicated PDA is supplied by branches of both the RCA and LAD or LCx.

Although the RCA is the dominant vessel in most hearts, it is important to consider that it is usually the left main that supplies the majority of the left ventricular myocardium as well as the anterior and mid 2/3^rds of the interventricular septum.

Clinical relevance

Dominance has important implications in myocardial ischemia and infarction, imaging of the coronary arteries (CTCA and invasive coronary angiography) and the planning for coronary artery bypass grafting.

References

Anatomy: Thoracic

thoracic skeleton
- thoracic cage
  - ribs
    - typical ribs
    - atypical ribs
    - variant anatomy
      - bifid ribs
  - costal cartilage
  - sternum
- thoracic spine
- articulations
muscles of the thorax
spaces of the thorax
thoracic viscera
blood supply of the thorax
- arteries
  - thoracic aorta (development)
  - pulmonary trunk
    - left pulmonary artery
      - aberrant left pulmonary artery
    - right pulmonary artery
- veins
  - superior vena cava (cavoatrial junction)
  - inferior vena cava
  - coronary veins
    - cardiac veins which drain into the coronary sinus
      - great cardiac vein
      - middle cardiac vein
      - small cardiac vein
      - posterior vein of the left ventricle
      - vein of Marshall (oblique vein of the left atrium)
    - anterior cardiac veins
    - venae cordis minimae (smallest cardiac veins or thebesian veins)
  - pulmonary veins
    - bronchial veins
lymphatics
innervation of the thorax

Article information

rID: 40290

System: Cardiac

Section: Anatomy

Synonyms or Alternate Spellings:

Dominance of the coronary arteries
Cardiac arterial dominance
Coronary artery dominance
Coronary dominance
Cardiac dominance
Dominance of coronary arteries

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Cases and figures

Case 1: right dominant circulationCase 1: right dominant circulation

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Case 2: left dominant circulationCase 2: left dominant circulation

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