IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 7 Ver. III (July. 2015), PP 55-59
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Coronary Dominance in Fetuses of Manipuri Origin

Bidyarani Yumnam1, Aribam Jaishree Devi2,
Nongthombam Saratchandra Singh3.
1: Postgraduate student,2: Associate professor,3: Professor, Department of Anatomy,
Regional Institute of Medical Sciences, Imphal, Manipur, India.

Abstract: The cardiovascular system is the first organ system of an embryo to reach a functional state. The
heart is supplied by the right and left coronary arteries which arise from the ascending aorta. The artery giving
off the posterior interventricular branch is defined as the dominant artery. Materials and method: Thirty fetal
hearts ranging from gestational age of 17 wks to 40 wks are studied. Results and observation: Right dominance
in 70%, left dominance in 20% and co dominant in 10%. Myocardial bridges are also a common finding in the
course of the arteries. Conclusion: This study provides potentially useful information for the preoperative
evaluation of the newborn.
Keywords: coronary artery, fetal hearts, dominance, co dominant or balanced, myocardial bridges.

I.

Introduction

The cardiovascular system is the first major system to function in the embtyo. The primordial heart and
vascular system appear in the middle of the third week. 1The normal coronary vasculature of the embryonic
human heart begins as a group of epi-cardial blood islands, endothelium-lined cysts filled with nucleated
erythrocytes, in the apical interventricular sulcus. Coronary artery arises normally only from the juxtapulmonary
aortic sinuses.2
The right and left coronary arteries arise from the ascending aorta. The right coronary artery gives off
the conus artery as its first branch. The right marginal artery is long enough to reach the apex in most hearts. As
the right coronary approaches the crux of the heart, it normally produces one to three posterior interventricular
branches (occasionally there are none). One, of them lies in the interventricular groove as the posterior
interventricular artery. The left coronary divides into two or three main branches. The anterior interventricular
artery is commonly described as the continuation of left coronary artery. The left diagonal artery reach the
rounded (obtuse) left border. The circumflex artery, comparable to the anterior interventricular artery in calibre,
curves left in the atrioventricular groove, continuing round the left cardiac border into the posterior part of the
groove and ending left of the crux in most hearts, but sometimes continuing as a posterior interventricular
artery.3The artery giving off the posterior interventricular branch is defined as the dominant artery. In a balanced
circulation, branches of both arteries run in or near the posterior interventricular groove. 4 The dominant artery is
usually the right in 67% of the population. In approximately 15% of hearts the left coronary artery is dominant
in that the posterior interventricular artery is a branch of the circumflex artery. There is co-dominance in
approximately 18% of people, in which branches of both the right and left coronary artery reach the crux of the
heart and give rise to branches that course in or near the posterior interventricular groove. 5 Anastomoses
betwesen right and left coronary arteries are abundant during fetal life, but are much reduced by the end of the
first year of life.3
The situation of coronary arteries is usually subepicardial, but can delve into the myocardium and then
reappear on the surface of the heart. Thus the bundle of myocardial fibre which overlaps one segment of
coronary artery is defined the myocardial bridge. 6
Knowledge of the normal and variant anatomy and anomalies of coronary circulation is an increasingly
vital component in the management of congenital and acquired heart diseases. Congential, inflammatory,
metabolic and degenerative diseases may involve the coronary circulation and increasingly complex cardiac
surgical repairs demand enhanced understanding of the basic anatomy to improve the operative outcomes.7

II.

Materials And Method

Thirty fetuses of gestational age of 17 weeks to 40 weeks are collected from the department of
Obstetrics and Gynaecology,RIMS. Prior to collection of fetuses permission is sought from the Institutional
Ethics Committee. The fetuses are categorised into 4 groups randomly depending on their gestational age as
group 1, group 2, group 3 and group 4 ranging from 17 weeks to 22 weeks, 23 weeks to 28 weeks, 29 weeks to
34 weeks and 35 weeks to 40 weeks of gestation respectively (Fig 1). The fetuses are then fixed in 10%
formalin. The thorax is opened to remove the heart. Gross anatomy of the heart is studied and the coronary
arteries are traced to their termination. Photographs of relevant areas are taken.
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Coronary Dominance In Fetuses Of Manipuri Origin

III.

Results And Observation

In group 1, right dominance is observed in 2 specimens and co-dominance in 1 specimen. In group 2,

right dominance is seen in 2 specimens and 3 specimens show left dominance. In group 3, right dominance is
seen in 8 specimens, 2 specimens shows left dominance and 1 shows co-dominance. In group 4, right
dominance is seen in 9 specimens, 1 specimen shows left dominance and 1 shows co-dominance. Out of the
total 30 fetal heart specimens right dominance is observed in 21, left dominance in 6 and co-dominance in 3 of
the specimens (Fig 2, Fig 3, Fig 4).
The site of the termination of right coronary artery is also taken into consideration and it is observed
that the artery terminates at the right acute border in 16.6% (5 no.), between the right border and crux in 3.3% (1
no.), at the crux in 13.3% (4 no.), between the crux and left obtuse border in43.3% (13 no.) and at the left obtuse
border in 23.3% (7 no.).
Myocardial bridge is also a very common observation in many of the fetal hearts in the present study
(Fig 5). It is seen in 36.6% (11 no.) of the heart specimen.

IV.

Discussion

The present study observes 70%, 20% and 10% respectively of right dominance, left dominance and
co-dominance in the fetal heart specimens. It is also observed that the right coronary artery crosses crux of the
heart and lie near or at the obtuse border in 66.6% of the study sample.
In a study done by Kandregula J et al it was seen that the percentage incidence of dominance based on
the origin of posterior interventricular branch in a sample of aborted fetuses were 56%, 38% and 6%
respectively for right, left and balanced dominance.8 In their findings left dominancy was reported higher as
compared to the present study. This is the only available study done on fetuses regarding cardiac dominancy,
other studies are done on adults.
Right coronary dominancy was found to be the most frequently observed in studies conducted by most
of the authors. Shukri IG et al reported that 65% was right dominant circulation, 27% mixed circulation and 8%
were left dominant circulation.9 In a study done by Kalpana R, the Right coronary artery was the dominant
artery in 89% and the Left in 11% of the specimens. 7 Fazliogullari Z et al reported that coronary dominance of
all hearts were 42%, 14% and 44% respectively of right dominance, left dominance and equal dominance. 10
They reported a higher incidence of equal dominance as compared to the present study. In an Assamese
population, Das H et al reported 70% were right dominant, 18.5% and 11.43% were left dominant and codominant respectively.11 The findings of Das H et al are closer to the findings of present study. Reddy VJ et al
reported that in a South Indian population right dominance was 86.25%, left dominance was 11.26% and codominant was 2.5%.19
The overall prevalence of the myocardial bridging was found to be 70% in the study sample of
Swaroop N et al. They reported that myocardial bridges were distributed more over left coronary artery in right
dominant hearts. The anatomical relation of the myocardial fibres in those with long and deep myocardial
bridges can distort the coronary artery that can be identified angiographically. The possibility of bridges should
be borne in mind in individuals with ischemia but no evidence of coronary atherosclerosis. 12
The possible clinical implications of myocardial bridging may vary from protection against
atherosclerosis to systolic vessel compression and resultant myocardial ischaemia as reported by Loukas M et al.
The coronary dominance of all of the hearts in their study was as follows: 55% were right dominant, 33% left
dominant and 12% codominant; 66.6% of the hearts with bridges were left dominant. 13
Myocardial bridging has been associated with angina, myocardial infarction, and sudden death.
Ironically, the bridged segment is rarely affected by atherosclerosis and can easily go unrecognised on cine
arteriography as what otherwise appears to be a normal coronary artery.14
Kura GG et al also reported a case of myocardial bridge in the branches of left coronary artery, which
showed a trifurcation of anterior interventricular, left circumflex and median artery. 15
Abuchaim DCS et al also reported 72%, 20% and 8% of right dominant, left dominant and codominant
respectively. He also reported that no anastomosis were present between the two coronary system in their study
sample.16
In patients referred for Computed tomography coronary angiography a left dominant coronary artery
system was identified as a significant risk factor for myocardial infarction and death. Particularly in the
subgroup of patients with significant coronary artery disease on computed tomography coronary angiography,
those patients with a left dominant coronary artery system had a strongly increased risk of events compared with
patients with a right dominant coronary artery system. Therefore, the potential indication for intensive treatment
could be more prominent in patients with a left dominant coronary artery system.17

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Coronary Dominance In Fetuses Of Manipuri Origin

V.

Conclusion

The present study concludes that in fetuses of Manipuri origin which is ethnically and racially different
from the mainland Indians, in the majority of the heart i.e in 70% of the sample the right coronary artery is the
dominant artery. However further studies are suggested in a larger study sample and the association of
myocardial bridges in the course of coronary artery. This study will be of value to surgeons while undergoing
coronary intervention in the newborn.
Photograph
CODOMINANCE

RIGHT

LEFT

35-40
wks

29-34
wks

23-28
wks
17-22
wks

Fig 1: specimens of fetal heart arranged according to gestational age

RIGHT CORONARY ARTERY

POSTERIOR INTERVENTRICULAR
ARTERY

Fig 2: Diaphragmatic surface of heart

showing right dominance

LEFT DOMINANCE

LEFT CORONARY ARTERY

POSTERIOR INTERVENTRICULAR
ARTERY

Fig 3: Left dominance

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Coronary Dominance In Fetuses Of Manipuri Origin

LEFT CORONARY ARTERY

RIGHT CORONARY ARTERY

POSTERIOR INTERVENTRICULAR
ARTERY

Fig 4: Balance pattern

MYOCARDIAL BRIDGE

Fig 5: Myocardial bridge in the course of right coronary artery

GESTATIONAL AGE IN
WEEKS
17-22
23-28
29-34
35-40

RESULTS
RIGHT DOMINANT
LEFT DOMINANT

BALANCED PATTERN

2
2
8
9

1
1
1

3
2
1

Table1: Result of the present study

STUDY
PRESENT
JAMES 18
FISS DM14
ABUCHAIM DCS 16
DAS H11
FAZLIOGULL ARI SZ10
REDDY VJ19
SHUKRI IG9
KALPANA R7
LOUKAS M13

COMPARISONS WITH THE RESULT OF OTHER AUTHOR

RIGHT DOMINANCE
LEFT DOMINANCE
BALANCE
PATTERN
70%
20%
10%
95.34%
85%
8%
7%
72%
20%
8%
70%
18.57%
14.43%
42%
14%
44%
86.25%
11.26%
2.5%
65%
27%
8%
89%
11%
55%
33%
12%

Table 2: Table showing the comparison of the present study with other study
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Coronary Dominance In Fetuses Of Manipuri Origin

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