Mean right coronary artery
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Mean Right Coronary Artery: Morphometric and Clinical Insights
Morphometric Characteristics of the Right Coronary Artery
Length and Diameter
The right coronary artery (RCA) exhibits significant variability in its morphometric characteristics. A study examining 30 preserved hearts found that the first segment of the RCA has a length ranging from 5.7 to 8.0 cm, with a mean length of 6.3 ± 0.6 cm. The external diameter of this segment ranges from 4.0 mm to 7.0 mm, with a mean diameter of 5.1 ± 0.7 mm. The second segment of the RCA ranges from 3.4 to 6.0 cm in length, with a mean of 4.9 ± 0.7 cm, and its external diameter ranges from 3.1 mm to 5.6 mm, with a mean of 4.3 ± 0.8 mm1.
Branches and Origins
The RCA typically gives rise to several important branches. The right conus artery arises at a distance of 0.5 to 2.4 cm from the beginning of the RCA, with a mean distance of 1.5 ± 0.6 cm. The sinoatrial node (SAN) branch originates at a distance of 0.6 to 2.6 cm from the RCA's beginning, with a mean distance of 1.6 ± 0.6 cm. The acute marginal branch arises at a distance of 2.7 to 5.6 cm, with a mean distance of 4.2 ± 0.8 cm from the RCA's origin. The posterior interventricular branch and the atrioventricular node (AVN) artery consistently originate from the RCA at the cardiac crux1.
Anatomical Variations in Vietnamese Population
In a study focusing on Vietnamese cadavers, the RCA was found to originate from the right aortic sinus in all hearts examined. The mean diameter and length of the RCA were 4.21 mm ± 0.64 mm and 122.5 mm ± 17.8 mm, respectively. The RCA terminated between the crux and the left border in 72% of cases and at the crux in 14.4% of cases. The sinoatrial node artery originated from the RCA in 81.6% of hearts, from the left circumflex artery (LCX) in 16.8%, and from both the RCA and LCX in 1.6% of cases. The conus artery originated from the RCA in 68.8% of hearts, from the right aortic sinus at the same site as the RCA in 8.8%, and away from this site in 22.4% of cases4.
Clinical Implications of RCA Variations
Anomalous Origin and Congenital Absence
Anomalous origin of the RCA from the pulmonary artery (ARCAPA) is a rare congenital anomaly that can present with a wide range of symptoms, from asymptomatic murmurs to sudden cardiac death. This condition is most commonly diagnosed with coronary angiography and is typically treated surgically, with re-implantation of the RCA onto the aorta being the most common method of repair3. Additionally, the RCA arising from the left sinus of Valsalva as a branch of a single coronary artery is an extremely rare phenomenon, seen in less than 1% of the population, and can lead to severe complications such as spasm, ischemia, and sudden cardiac death2.
Coronary Artery Fistula
Coronary artery fistula, although rare, most commonly affects the right side of the heart. It can occur in isolation or alongside congenital heart diseases. Angiography is the best diagnostic tool for this condition. While usually asymptomatic in younger patients, symptoms and complications increase with age. Early treatment through transcatheter or surgical closure yields the best outcomes5.
Conclusion
Understanding the morphometric and anatomical variations of the right coronary artery is crucial for cardiologists and cardiac surgeons. These variations can significantly impact the diagnosis, treatment, and management of coronary artery diseases and congenital anomalies. The detailed morphometric data and clinical insights provided by recent studies underscore the importance of personalized approaches in interventional cardiology and cardiac surgery.
Sources and full results
Most relevant research papers on this topic
A CASE OF A CONGENITALLY ABSENT RIGHT CORONARY ARTERY
Congenially absent right coronary artery can lead to spasm, ischemia, and sudden cardiac death, and should be considered a rare phenomenon.
Case Report
Very Rigorous JournalAnomalous Origin of the Right Coronary Artery from the Pulmonary Artery: A Systematic Review.
ARCAPA is a rare congenital coronary anomaly with variable clinical presentation, and understanding its pathophysiology is crucial for determining treatment strategies.
Systematic ReviewA morphometric anatomical study of the right coronary artery in Vietnamese
The right coronary artery in Vietnamese hearts shows morphometric variations, which can cause difficulties in imaging interpretation and intervention procedures.
Coronary artery fistula.
Coronary artery fistula is a rare but common anomaly, most commonly affecting the right side of the heart, with early treatment by transcatheter or surgical closure yielding the best results.
Systematic Review
Highly CitedMorphological Study of Right and Left Coronary Artery: A Cadaveric Study
Right coronary dominance is most common, while the left coronary artery shows more variations than the right, which may aid in academic, medical, and surgical management.
Right coronary artery originating from distal left circumflex: an extremely rare variety of single coronary artery.
Right coronary artery originating from distal left circumflex is an extremely rare variety of single coronary artery, with no other associated cardiac anomalies.
Case ReportMajor anomalies of coronary arterial origin seen in adulthood.
Anomalies of coronary arterial origin are common in adult hearts without other major malformations of the heart or great vessels.
Highly CitedTHE HIGH TAKEOFF RIGHT CORONARY ARTERY
High takeoff of the right coronary artery is more common than the left coronary artery, and its presence can lead to decreased coronary perfusion, potentially leading to myocardial ischemia and sudden death.
Double right coronary artery or split right coronary artery?
A consensus on the definition of a double right coronary artery is needed to avoid confusion and improve diagnostic criteria for this rare congenital coronary anomaly.
Systematic Review
Rigorous Journal