Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Background: Coronary dominance refers to the arterial branching pattern supplying the inferior wall of the heart. Approximately 70–80% of individuals exhibit right-coronary dominance, in which the posterior descending artery (PDA) arises from the right coronary artery (RCA). Left-coronary dominance occurs in about 5–10% of the population and is defined by the PDA originating from the left circumflex artery (LCX), while codominance—where the PDA is supplied by both the RCA and LCX—occurs in 10–20% of individuals. Differences in myocardial perfusion have been observed among dominance patterns: right dominance typically results in the RCA supplying the inferior and inferoseptal ventricles, whereas left dominance involves more equal contribution from both coronary systems. Clinically, left-coronary dominance has been associated with poorer outcomes following myocardial revascularization, potentially due to reduced collateral circulation. Anatomically, the LCX in left-dominant hearts lies closer to the mitral valve annulus, increasing the risk of vascular injury during mitral valve replacement. Additionally, left-coronary dominance has been linked to increased non-obstructive atherosclerosis, worse outcomes after percutaneous coronary intervention (PCI) for acute coronary syndrome, higher incidence of atrial fibrillation, and prolonged P-wave duration. Although ST-elevation myocardial infarction (STEMI) is more frequently associated with right dominance, left-dominant patients experience higher STEMI-related mortality. This cadaveric study contributes to the limited anatomical literature on left-coronary dominance and its implications for cardiac perfusion.
Methods: A donor cadaver was dissected in the gross anatomy laboratory at Philadelphia College of Osteopathic Medicine–South Georgia (PCOM SGA). Superficial thoracic structures were reflected, and an incision was made approximately 1.5 cm superior to the emergence of the great vessels. The posterior serous pericardium was removed, and the heart was excised and examined. The RCA, right marginal artery, left coronary artery, LCX, left anterior descending artery, and PDA were bluntly dissected and evaluated for anatomical variation.
Results: Gross examination of the heart demonstrated left-coronary dominance as the PDA originates from the LCX artery.
Discussion & Conclusion: This cadaveric study identified left-coronary dominance in an 89-year-old donor, characterized by the PDA branching from the LCX rather than the RCA. The reported cause of death was cerebrovascular disease, and no gross cardiac abnormalities such as fibrosis, necrosis, edema, or discoloration were observed. While the contribution of coronary dominance to the patient’s clinical history cannot be determined, this finding highlights the anatomical and clinical relevance of coronary variation. Recognition of coronary dominance is essential for procedural planning in PCI, ablation, coronary artery bypass grafting, and coronary angiography. Future studies should incorporate computational coronary flow modeling to further evaluate ischemic risk associated with coronary anatomical variation.
Embargo Period
5-29-2026
Included in
Evaluation of left-coronary dominance and its effect on cardiac perfusion: A cadaveric study
Moultrie, GA
Background: Coronary dominance refers to the arterial branching pattern supplying the inferior wall of the heart. Approximately 70–80% of individuals exhibit right-coronary dominance, in which the posterior descending artery (PDA) arises from the right coronary artery (RCA). Left-coronary dominance occurs in about 5–10% of the population and is defined by the PDA originating from the left circumflex artery (LCX), while codominance—where the PDA is supplied by both the RCA and LCX—occurs in 10–20% of individuals. Differences in myocardial perfusion have been observed among dominance patterns: right dominance typically results in the RCA supplying the inferior and inferoseptal ventricles, whereas left dominance involves more equal contribution from both coronary systems. Clinically, left-coronary dominance has been associated with poorer outcomes following myocardial revascularization, potentially due to reduced collateral circulation. Anatomically, the LCX in left-dominant hearts lies closer to the mitral valve annulus, increasing the risk of vascular injury during mitral valve replacement. Additionally, left-coronary dominance has been linked to increased non-obstructive atherosclerosis, worse outcomes after percutaneous coronary intervention (PCI) for acute coronary syndrome, higher incidence of atrial fibrillation, and prolonged P-wave duration. Although ST-elevation myocardial infarction (STEMI) is more frequently associated with right dominance, left-dominant patients experience higher STEMI-related mortality. This cadaveric study contributes to the limited anatomical literature on left-coronary dominance and its implications for cardiac perfusion.
Methods: A donor cadaver was dissected in the gross anatomy laboratory at Philadelphia College of Osteopathic Medicine–South Georgia (PCOM SGA). Superficial thoracic structures were reflected, and an incision was made approximately 1.5 cm superior to the emergence of the great vessels. The posterior serous pericardium was removed, and the heart was excised and examined. The RCA, right marginal artery, left coronary artery, LCX, left anterior descending artery, and PDA were bluntly dissected and evaluated for anatomical variation.
Results: Gross examination of the heart demonstrated left-coronary dominance as the PDA originates from the LCX artery.
Discussion & Conclusion: This cadaveric study identified left-coronary dominance in an 89-year-old donor, characterized by the PDA branching from the LCX rather than the RCA. The reported cause of death was cerebrovascular disease, and no gross cardiac abnormalities such as fibrosis, necrosis, edema, or discoloration were observed. While the contribution of coronary dominance to the patient’s clinical history cannot be determined, this finding highlights the anatomical and clinical relevance of coronary variation. Recognition of coronary dominance is essential for procedural planning in PCI, ablation, coronary artery bypass grafting, and coronary angiography. Future studies should incorporate computational coronary flow modeling to further evaluate ischemic risk associated with coronary anatomical variation.