An unusual anatomic variation of the Posterior Descending Coronary Artery
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ANATOMIC VARIATIONS
An unusual anatomic variation of the Posterior Descending Coronary Artery Stratinaki Maria1 · Sbarouni Eftιhia1 Received: 31 August 2020 / Accepted: 10 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose To report a rare coronary anatomic variation. Methods Review of the coronary angiogram of a patient with evidence of myocardial ischemia. Results The posterior descending artery was aberrant, originating from a large intermediate brunch. Conclusion This anatomic variation has not been previously described. Keywords Coronary anatomy · Myocardial ischemia · Coronary anomaly · Posterior descending artery
Introduction
Results
Posterior Descending Coronary Artery (PDA) is a term to describe the inferior interventricular artery; PDA is frequently quoted by cardiologists and cardiothoracic surgeons, however inferior interventricular artery represents a more precise anatomical and operative description. It usually (85%) arises from the right coronary artery (RCA) and this represents right dominant circulation; it may also originate from the circumflex artery (15%), as its continuation, this being left dominant circulation, and very rarely appears as a branch of the left anterior descending (LAD) [2, 4]. A balanced type, with two PDAs—one from each coronary artery—has also been described [6].
On angiography his left coronary artery was ectatic with trifurcation anatomy and free of atherosclerosis. A short LAD was present, as an anatomical variant. His right coronary artery was non-dominant and similarly with no abnormalities, providing acute marginal branches but terminating before the crux (Figs. 1, 2). Interestingly, his PDA was the continuation of the intermediate branch. The PDA was an aberrant, slender and straight vessel, running along the posterior interventricular groove (Fig. 3).
Methods A 72-year-old man with exertional angina and a negative maximal exercise test attended outpatients clinic in our hospital. A subsequent Thallium-SPECT showed reduced uptake in inferior, posterior and postero-basal segments without redistribution and his left ventricle on echo was normal without regional wall motion abnormalities.
* Stratinaki Maria [email protected] 1
Department of Interventional Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece
Discussion Our case illustrates a very rare anatomical coronary variation of a posterior interventricular artery arising as the terminal branch of a ramus intermedius. The left coronary artery usually divides into two arteries; a third one, ramus intermedius, is present in approximately 20% of coronary angiograms [5]; rarely trifurcation anatomy may exist without left main, with all three arteries arising directly from the left aortic sinus. Our patient had no evidence of atherosclerosis in the coronary tree, abnormal intra- or inter-coronary anastomoses, occluded coronary branches or collaterals. The PDA approached the crux of the heart, also giving rise to small septal branches. Coronary artery
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