J Thorac Cardiovasc Surg 1995;109:188-189
© 1995 Mosby, Inc.
Classification of variant courses of the posterior descending artery
Tom Treasure, MD, MS, FRCS
Consultant Cardiothoracic Surgeon
St. George's Hospital
Blackshaw Road
London SW17 0QT, United Kingdom
To the Editor:
I was interested in the anatomic study on the posterior descending artery performed by Arsiwala and Panday (J THORAC CARDIOVASC SURG 1993;105:952-3) and the surgical inferences drawn.
I was taught about this anatomic variation in the branching of the right coronary artery by John E C. Wright of the London Chest Hospital. We subsequently did a small study to define the prevalence of different branching patterns (Adams and Treasure, Thorax 1985;40:618-20). We studied angiograms (n = 100), the coronary anatomy as displayed at operation (n = 100), and postmortem dissections (n = 22). We classified them into three patterns (Fig. 1): bifurcation at the crux (A), at the acute margin (B), or in an intermediate position (C). The frequencies are given in Table I.
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Fig. 1. Anatomy of the right coronary artery as seen at operation, with the inferior surface displayed by turning the apex upwards. A, The "normal" anatomy of a dominant right coronary artery (rca) with the posterior descending coronary artery (pd) arising at the crux (x). B, The acute marginal artery (am) itself reaching the interventricular groove. C, The right coronary artery bifurcating about two thirds of the way from the acute margin to the crux.(From Adams J, Treasure T. Variable anatomy of the right coronary artery supply to the left ventricle. Thorax 1985;40:618-20. Published with the permission of BMJ Publishing Group.)
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Our conclusions were the same as those reached by Arsiwala and Panday.
