Arterial Supply of Atrioventricular Node and Bundle in Relation to Degree of Stenosis of Coronary Artery among Sudanese Population (Coronary Angiography Study)
Author(s)
Khalid M. Taha1,
Abubaker Y. Elamin2,3,4,
Mohammed H. Karrar Alsharif2,5,
Deya Eldin A. Mohamed4,6
Affiliation(s)
1 Anatomy Department, Faculty of Medicine, Karary University, Omdurman, Sudan. 2 Anatomy Department, Faculty of Medicine, University of Science and Technology, Khartoum, Sudan. 3 Emergency Medical Specialtist Department, Al-Ghad International Colleges for Applied Medical Sciences, Al Madinah Al Munawarah, KSA. 4 Anatomy Department, School of Medicine, Ahfad University for Women, Omdurman, Sudan. 5 Anatomy Department, Prince Sattam Bin Abdulaziz University, Al-Kharj, KSA. 6 Department of Medical Imaging, Al-Ghad International College for Applied Medical Sciences, Dammam, KSA.
1 Anatomy Department, Faculty of Medicine, Karary University, Omdurman, Sudan. 2 Anatomy Department, Faculty of Medicine, University of Science and Technology, Khartoum, Sudan. 3 Emergency Medical Specialtist Department, Al-Ghad International Colleges for Applied Medical Sciences, Al Madinah Al Munawarah, KSA. 4 Anatomy Department, School of Medicine, Ahfad University for Women, Omdurman, Sudan. 5 Anatomy Department, Prince Sattam Bin Abdulaziz University, Al-Kharj, KSA. 6 Department of Medical Imaging, Al-Ghad International College for Applied Medical Sciences, Dammam, KSA.
ABSTRACT
The coronary arteries diseases are one of the most causes of mortality and morbidity worldwide, particularly in the developing countries. Coronary obstructions are generally described by location and severity of stenosis. Manual tracing and measurement of the stenosis vessel in comparison to reference location of stenosis can be helpful to classify whether a lesion is significant or not. The aim of this study is to identify the dominant type of circulation carried out in patients presented in heart institute and associated with degree of stenosis in RCA and LAD artery. Materials and Methods: This was a retrospective study carried out on patients reporting to Heart Institute from June 2013 to August 2013 (311 patients records as a total coverage were collected as sample) whose coronary artery angiography revealed pathology in coronary arteries. Result: The findings were 71.7% right dominant, 23.5% left dominant and 4.8% co-dominant; LAD tends to be stricture with right dominant circulation type. LAD artery tends to be stenosis at proximal and mid segment while in the RCA tends to be stenosis in mid and distal segments. The right dominant artery is popular type of circulation in Sudanese people reported in Sudan Heart Institute; there is no significance association between gender and arterial type of circulation and also degree stenosis in LAD degree of stenosis in RCA. I observed that the site of stenosis in LAD artery was proximal and mid (P value < 0.05 significance association). Conclusion: Patients present at the heart institute are right dominant mostly coming with proximal and middle LAD stenosis unlike RCA which commonly presents with distal and middle stenosis, so the middle segment of coronary artery is stenosis in both situations. There are wild variations in dominance artery in relation to reduction of diameter in deferent ethic group. There are no significant associations between the gender and dominant artery.
The coronary arteries diseases are one of the most causes of mortality and morbidity worldwide, particularly in the developing countries. Coronary obstructions are generally described by location and severity of stenosis. Manual tracing and measurement of the stenosis vessel in comparison to reference location of stenosis can be helpful to classify whether a lesion is significant or not. The aim of this study is to identify the dominant type of circulation carried out in patients presented in heart institute and associated with degree of stenosis in RCA and LAD artery. Materials and Methods: This was a retrospective study carried out on patients reporting to Heart Institute from June 2013 to August 2013 (311 patients records as a total coverage were collected as sample) whose coronary artery angiography revealed pathology in coronary arteries. Result: The findings were 71.7% right dominant, 23.5% left dominant and 4.8% co-dominant; LAD tends to be stricture with right dominant circulation type. LAD artery tends to be stenosis at proximal and mid segment while in the RCA tends to be stenosis in mid and distal segments. The right dominant artery is popular type of circulation in Sudanese people reported in Sudan Heart Institute; there is no significance association between gender and arterial type of circulation and also degree stenosis in LAD degree of stenosis in RCA. I observed that the site of stenosis in LAD artery was proximal and mid (P value < 0.05 significance association). Conclusion: Patients present at the heart institute are right dominant mostly coming with proximal and middle LAD stenosis unlike RCA which commonly presents with distal and middle stenosis, so the middle segment of coronary artery is stenosis in both situations. There are wild variations in dominance artery in relation to reduction of diameter in deferent ethic group. There are no significant associations between the gender and dominant artery.
Cite this paper
Taha, K. , Elamin, A. , Alsharif, M. , Mohamed, D. , (2015) Arterial Supply of Atrioventricular Node and Bundle in Relation to Degree of Stenosis of Coronary Artery among Sudanese Population (Coronary Angiography Study). World Journal of Cardiovascular Diseases, 5, 120-128. doi: 10.4236/wjcd.2015.55015.
Taha, K. , Elamin, A. , Alsharif, M. , Mohamed, D. , (2015) Arterial Supply of Atrioventricular Node and Bundle in Relation to Degree of Stenosis of Coronary Artery among Sudanese Population (Coronary Angiography Study). World Journal of Cardiovascular Diseases, 5, 120-128. doi: 10.4236/wjcd.2015.55015.
References
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http://dx.doi.org/10.1016/S0002-8703(40)90791-8 [4] Gawlikowska-Sroka, A., Miklaszewska, D. and Czerwinski, F. (2010) Analysis of the Influence of Heart Size and Gender on Coronary Circulation Type. Folia Morphologica, 69, 35-41. [5] Vieweg, W.V., Alpert, J.S. and Hagan, A.D. (1975) Origin of the Sinoatrial Node and Atrioventricular Node Arteries in Right, Mixed, and Left Inferioremphasis Systems. Catheterization and Cardiovascular Diagnosis, 1, 361-373.
http://dx.doi.org/10.1002/ccd.1810010405 [6] Standring, S. (2008) Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 40th Edition, Elsevier, St. Louis Sydney, 1576 p. [7] Sadler, T.W. (2011) Langman’s Medical Embryology. Lippincott Williams and Wilkins, Philadelphia, 384 p. [8] Factors, S.M., Lamberti-Abadi, M.A. and Abadi, J. (2001) Hand-book of Pathology and Pathophysiology of Cardiovascular Disease (Developments in Cardiovascular Medicine). 8th Edition, Kluwer Academic Publisher, Norwell, 312 p. [9] Ortale, J.R., Keiralla, L.C. and Sacilotto, L. (2004) The Posterior Ventricular Branches of the Coronary Arteries in the Human Heart. Arquivos Brasileiros de Cardiologia, 82, 468-472. [10] Fuster, V., Alexander, R.W. and Wellens, H.J.J. (2000) Hurst’s the Heart. 10th Edition, McGraw-Hill, Philadelphia, 1080 p. [11] Eren, S., Bayram, E., Fil, F., Koplay, M., Sirvanci, M., Duran, C., et al. (2008) An Investigation of the Association between Coronary Artery Dominance and Coronary Artery Variations with Coronary Arterial Disease by Multidetector Computed Tomographic Coronary Angiography. Journal of Computer Assisted Tomography, 32, 929-933.
http://dx.doi.org/10.1097/RCT.0b013e3181593d5b [12] Vasheghani-Farahani, A., Kassaian, S.E., Yaminisharif, A., Davoodi, G., Salarifar, M., Amirzadegan, A., et al. (2008) The Association between Coronary Arterial Dominancy and Extent of Coronary Artery Disease in Angiography and Paraclinical Studies. Clinical Anatomy, 21, 519-523.
http://dx.doi.org/10.1002/ca.20669 [13] Kronzon, I., Deutsch, P. and Glassman, E. (1974) Length of the Left Main Coronary Artery: Its Relation to the Pattern of Coronary Arterial Distribution. The American Journal of Cardiology, 34, 787-789.
http://dx.doi.org/10.1016/0002-9149(74)90697-3 [14] MacAlpin, R.N., Abbasi, A.S., Grollman Jr., J.H. and Eber, L. (1973) Human Coronary Artery Size during Life. A Cinearteriographic Study. Radiology, 108, 567-576.
http://dx.doi.org/10.1148/108.3.567 [15] Bergman, R.A., Thompson, S.A. and Afifi, A.K. (1988) Compendium of Human Anatomic Variation: Text, Atlas, and World Literature. Urban & Schwarzenberg, Baltimore, 607 p. [16] Vasko, J.S., Gutelius, J. and Sabiston Jr., D.C. (1961) A Study of Predominance of Human Coronary Arteries Determined by Arterio-graphic and Perfusion Technics. The American Journal of Cardiology, 8, 379-384.
http://dx.doi.org/10.1016/0002-9149(61)90157-6 [17] Cohn, P. and Goldberg, S. (1985) Cardiac Catheterization and Coronary Arteriography. In: Cohn, P.F., Ed., Diagnosis and Therapy of Coronary Artery Disease, Springer, New York, 219-260.
http://dx.doi.org/10.1007/978-1-4613-2569-7_9 [18] Chaudhry, M.S. (1965) Some Observation on the Coronary Artery Pattern and Inter-Coronary Anastomoses in Human Hearts. Medicus Karachi, 30, 160-172. [19] Murphy, E.S., Rosch, J. and Rahimtoola, S.H. (1977) Frequency and Significance of Coronary Arterial Dominance in Isolated Aortic Stenosis. The American Journal of Cardiology, 39, 505-509.
http://dx.doi.org/10.1016/S0002-9149(77)80158-6 [20] Hutchins, G.M., Nazarian, I.H. and Bulkley, B.H. (1978) Association of Left Dominant Coronary Arterial System with Congenital Bicuspid Aortic Valve. The American Journal of Cardiology, 42, 57-59.
http://dx.doi.org/10.1016/0002-9149(78)90985-2 [21] Mian, F.A., Malik, S.N., Ismail, M., Khan, I.S., Kachlu, A.R., Rehman, M., et al. (2011) Coronary Artery Dominance: What Pattern Exists in Pakistani Population? Annals of Pakistan Institute of Medical Sciences, 7, 3-5. [22] Kumar, K. (2012) Balanced or Co-Dominance Is an Impossible Coronary Arterial Pattern. Anatomica Karnataka, 6, 38-40. [23] Abuchaim, D.C.S., Spera, C.A., Faraco, D.L., Ribas Filho, J.M. and Malafaia, O. (2009) Coronary Dominance Patterns in the Human Heart Investigated by Corrosion Casting. Revista Brasileira de Cirurgia Cardiovascular, 24, 514-518. [24] Hussain, M., Nahar, A. and Ara, S. (2008) The Dominance Pattern of Coronary Artery of Adult Bangladeshi People— A Postmortem Morphological Study. Cardiovascular Journal, 1, 21-25. [25] Segall, G.M., Atwood, J.E., Botvinick, E.H., Dae, M.W. and Lucas, J.R. (1995) Variability of Normal Coronary Anatomy: Implications for the Interpretation of Thallium-SPECT Myocardial Perfusion Images in Single-Vessel Disease. Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine, 36, 944-951. [26] Lu, T.-M., Jou, Y.-L., Chen, Y.-H., Chen, L.-C., Sung, S.-H., Chan, W.-L. and Lin, S.-J. (2011) The Clinical Significance of Right Coronary Artery Stenosis on the Prognosis of Patients with Unprotected Left Main Disease Undergoing Percutaneous Coronary Intervention. Acta Cardiologica Sinica, 27, 14-20. [27] Bunce, N.H., Reyes, E., Keegan, J., Bunce, C., Davies, S.W., Lorenz, C.H., et al. (2004) Combined Coronary and Perfusion Cardiovascular Magnetic Resonance for the Assessment of Coronary Artery Stenosis. Journal of Cardiovascular Magnetic Resonance: Official Journal of the Society for Cardiovascular Magnetic Resonance, 6, 527-539. [28] Gensini, G.G. and Kisco, M. (1975) Coronary Arteriography. American Heart Journal, 407, 91. [29] Proudfit, W.L., Shirey, E.K. and Sones Jr., F.M. (1967) Distribution of Arterial Lesions Demonstrated by Selective Cinecoronary Arteriography. Circulation, 36, 54-62.
http://dx.doi.org/10.1161/01.CIR.36.1.54 [30] Wehrschuetz, M., Wehrschuetz, E., Schuchlenz, H. and Schaffler, G. (2010) Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner-Facing the Facts. Clinical Medicine Insights Cardiology, 4, 15-22.
http://dx.doi.org/10.4137/CMC.S3864 [31] Gerber, B.L., Coche, E., Pasquet, A., Ketelslegers, E., Vancraeynest, D., Grandin, C., et al. (2005) Coronary Artery Stenosis: Direct Comparison of Four-Section Multi-Detector Row CT and 3D Navigator MR Imaging for Detection— Initial Results. Radiology, 234, 98-108.
http://dx.doi.org/10.1148/radiol.2341031325 [32] Kaimkhani, Z.A., Ali, M.M. and Faruqi, A.M. (2005) Pattern of Coronary Arterial Distribution and Its Relation to Coronary Artery Diameter. Journal of Ayub Medical College, Abbottabad: JAMC, 17, 40-43.
[1] Mandal, S., Saha, J.B., Mandal, S.C., Bhattacharya, R.N., Chakraborty, M. and Pal, P.P. (2009) Prevalence of Ischemic Heart Disease among Urban Population of Siliguri, West Bengal. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 34, 19-23.
http://dx.doi.org/10.4103/0970-0218.44518 [2] Libby, P., Bonow, R.O., Mann, D.L., Zipes, D.P. and Libby, P. (2008) Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th Edition, Saunders, Philadelphia, 478 p. [3] Schlesinger, J.M. (1940) Relation of Anatomic Pattern to Pathologic Conditions of the Coronary Arteries. American Heart Journal, 20, 252.
http://dx.doi.org/10.1016/S0002-8703(40)90791-8 [4] Gawlikowska-Sroka, A., Miklaszewska, D. and Czerwinski, F. (2010) Analysis of the Influence of Heart Size and Gender on Coronary Circulation Type. Folia Morphologica, 69, 35-41. [5] Vieweg, W.V., Alpert, J.S. and Hagan, A.D. (1975) Origin of the Sinoatrial Node and Atrioventricular Node Arteries in Right, Mixed, and Left Inferioremphasis Systems. Catheterization and Cardiovascular Diagnosis, 1, 361-373.
http://dx.doi.org/10.1002/ccd.1810010405 [6] Standring, S. (2008) Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 40th Edition, Elsevier, St. Louis Sydney, 1576 p. [7] Sadler, T.W. (2011) Langman’s Medical Embryology. Lippincott Williams and Wilkins, Philadelphia, 384 p. [8] Factors, S.M., Lamberti-Abadi, M.A. and Abadi, J. (2001) Hand-book of Pathology and Pathophysiology of Cardiovascular Disease (Developments in Cardiovascular Medicine). 8th Edition, Kluwer Academic Publisher, Norwell, 312 p. [9] Ortale, J.R., Keiralla, L.C. and Sacilotto, L. (2004) The Posterior Ventricular Branches of the Coronary Arteries in the Human Heart. Arquivos Brasileiros de Cardiologia, 82, 468-472. [10] Fuster, V., Alexander, R.W. and Wellens, H.J.J. (2000) Hurst’s the Heart. 10th Edition, McGraw-Hill, Philadelphia, 1080 p. [11] Eren, S., Bayram, E., Fil, F., Koplay, M., Sirvanci, M., Duran, C., et al. (2008) An Investigation of the Association between Coronary Artery Dominance and Coronary Artery Variations with Coronary Arterial Disease by Multidetector Computed Tomographic Coronary Angiography. Journal of Computer Assisted Tomography, 32, 929-933.
http://dx.doi.org/10.1097/RCT.0b013e3181593d5b [12] Vasheghani-Farahani, A., Kassaian, S.E., Yaminisharif, A., Davoodi, G., Salarifar, M., Amirzadegan, A., et al. (2008) The Association between Coronary Arterial Dominancy and Extent of Coronary Artery Disease in Angiography and Paraclinical Studies. Clinical Anatomy, 21, 519-523.
http://dx.doi.org/10.1002/ca.20669 [13] Kronzon, I., Deutsch, P. and Glassman, E. (1974) Length of the Left Main Coronary Artery: Its Relation to the Pattern of Coronary Arterial Distribution. The American Journal of Cardiology, 34, 787-789.
http://dx.doi.org/10.1016/0002-9149(74)90697-3 [14] MacAlpin, R.N., Abbasi, A.S., Grollman Jr., J.H. and Eber, L. (1973) Human Coronary Artery Size during Life. A Cinearteriographic Study. Radiology, 108, 567-576.
http://dx.doi.org/10.1148/108.3.567 [15] Bergman, R.A., Thompson, S.A. and Afifi, A.K. (1988) Compendium of Human Anatomic Variation: Text, Atlas, and World Literature. Urban & Schwarzenberg, Baltimore, 607 p. [16] Vasko, J.S., Gutelius, J. and Sabiston Jr., D.C. (1961) A Study of Predominance of Human Coronary Arteries Determined by Arterio-graphic and Perfusion Technics. The American Journal of Cardiology, 8, 379-384.
http://dx.doi.org/10.1016/0002-9149(61)90157-6 [17] Cohn, P. and Goldberg, S. (1985) Cardiac Catheterization and Coronary Arteriography. In: Cohn, P.F., Ed., Diagnosis and Therapy of Coronary Artery Disease, Springer, New York, 219-260.
http://dx.doi.org/10.1007/978-1-4613-2569-7_9 [18] Chaudhry, M.S. (1965) Some Observation on the Coronary Artery Pattern and Inter-Coronary Anastomoses in Human Hearts. Medicus Karachi, 30, 160-172. [19] Murphy, E.S., Rosch, J. and Rahimtoola, S.H. (1977) Frequency and Significance of Coronary Arterial Dominance in Isolated Aortic Stenosis. The American Journal of Cardiology, 39, 505-509.
http://dx.doi.org/10.1016/S0002-9149(77)80158-6 [20] Hutchins, G.M., Nazarian, I.H. and Bulkley, B.H. (1978) Association of Left Dominant Coronary Arterial System with Congenital Bicuspid Aortic Valve. The American Journal of Cardiology, 42, 57-59.
http://dx.doi.org/10.1016/0002-9149(78)90985-2 [21] Mian, F.A., Malik, S.N., Ismail, M., Khan, I.S., Kachlu, A.R., Rehman, M., et al. (2011) Coronary Artery Dominance: What Pattern Exists in Pakistani Population? Annals of Pakistan Institute of Medical Sciences, 7, 3-5. [22] Kumar, K. (2012) Balanced or Co-Dominance Is an Impossible Coronary Arterial Pattern. Anatomica Karnataka, 6, 38-40. [23] Abuchaim, D.C.S., Spera, C.A., Faraco, D.L., Ribas Filho, J.M. and Malafaia, O. (2009) Coronary Dominance Patterns in the Human Heart Investigated by Corrosion Casting. Revista Brasileira de Cirurgia Cardiovascular, 24, 514-518. [24] Hussain, M., Nahar, A. and Ara, S. (2008) The Dominance Pattern of Coronary Artery of Adult Bangladeshi People— A Postmortem Morphological Study. Cardiovascular Journal, 1, 21-25. [25] Segall, G.M., Atwood, J.E., Botvinick, E.H., Dae, M.W. and Lucas, J.R. (1995) Variability of Normal Coronary Anatomy: Implications for the Interpretation of Thallium-SPECT Myocardial Perfusion Images in Single-Vessel Disease. Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine, 36, 944-951. [26] Lu, T.-M., Jou, Y.-L., Chen, Y.-H., Chen, L.-C., Sung, S.-H., Chan, W.-L. and Lin, S.-J. (2011) The Clinical Significance of Right Coronary Artery Stenosis on the Prognosis of Patients with Unprotected Left Main Disease Undergoing Percutaneous Coronary Intervention. Acta Cardiologica Sinica, 27, 14-20. [27] Bunce, N.H., Reyes, E., Keegan, J., Bunce, C., Davies, S.W., Lorenz, C.H., et al. (2004) Combined Coronary and Perfusion Cardiovascular Magnetic Resonance for the Assessment of Coronary Artery Stenosis. Journal of Cardiovascular Magnetic Resonance: Official Journal of the Society for Cardiovascular Magnetic Resonance, 6, 527-539. [28] Gensini, G.G. and Kisco, M. (1975) Coronary Arteriography. American Heart Journal, 407, 91. [29] Proudfit, W.L., Shirey, E.K. and Sones Jr., F.M. (1967) Distribution of Arterial Lesions Demonstrated by Selective Cinecoronary Arteriography. Circulation, 36, 54-62.
http://dx.doi.org/10.1161/01.CIR.36.1.54 [30] Wehrschuetz, M., Wehrschuetz, E., Schuchlenz, H. and Schaffler, G. (2010) Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner-Facing the Facts. Clinical Medicine Insights Cardiology, 4, 15-22.
http://dx.doi.org/10.4137/CMC.S3864 [31] Gerber, B.L., Coche, E., Pasquet, A., Ketelslegers, E., Vancraeynest, D., Grandin, C., et al. (2005) Coronary Artery Stenosis: Direct Comparison of Four-Section Multi-Detector Row CT and 3D Navigator MR Imaging for Detection— Initial Results. Radiology, 234, 98-108.
http://dx.doi.org/10.1148/radiol.2341031325 [32] Kaimkhani, Z.A., Ali, M.M. and Faruqi, A.M. (2005) Pattern of Coronary Arterial Distribution and Its Relation to Coronary Artery Diameter. Journal of Ayub Medical College, Abbottabad: JAMC, 17, 40-43.