Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:1006 - Vol. 70 Num.11 DOI: 10.1016/j.rec.2017.02.011

Super Dominant Left Anterior Descending Coronary Artery

Suilbert Rodríguez-Blanco a,, Manuel Valdés-Recarey a, Abel Y. Leyva Quert a

a Departamento de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba

Article

The posterior descending artery or posterior interventricular (PIV) artery originates from the right coronary artery (RCA) in 85% of individuals, and from the circumflex artery (LCX) in 10% to 15%. The origin of the PIV, and of at least 1 posterolateral (PL) artery, determines the coronary dominance pattern, which is relevant in the prognosis of patients with coronary disease. We present 2 cases with a diagnosis of chronic stable exertional angina of Canadian Cardiovascular Society class III, who were referred for coronary angiography. In the first patient, angiography showed no significant lesions, and a left anterior descending artery (LAD) that reached the apex and continued ascending in the posterior interventricular groove until the crux cordis, with the PIV originating at the apex (Figure 1, Figure 1, Figure 1, Figure 1, arrows). The circumflex artery gave rise to 4 PL branches (Figure 1), and the RCA, which was of small caliber and underdeveloped, terminated at the acute margin on the heart (Figure 1). In the second patient, the LAD was a tortuous vessel that bordered the apex and gave rise to the PIV, which ascended along the homonymous groove until the crux cordis, where it continued as a PL branch (Figure 2, Figure 2, Figure 2, Figure 2, arterial flow sequence). The RCA was of small caliber. In such cases, the LAD takes on greater anatomical and functional importance, not just because of the large territory it supplies (which implies catastrophic clinical consequences if the vessel is acutely occluded), but also because of its length and spatial distribution, which could affect normal coronary perfusion. In both patients, medical treatment was optimized by increasing the dose of beta blockers and statins, which achieved clinical improvement.

Figure 1.

Figure 2.

Corresponding author: suilbert@infomed.sld.cu

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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