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Francisco Pérez-Rojas 1 2 3. Karla Gambeta-Tessini 4. Ricardo Puebla-Wuth 5. Eduardo F Olavarría-Solís 6. Patricio Maragaño-Lizama 6. Enrique Olave 7. Difference between dominance and codominance class 12 knowledge and understanding of coronary arteries and difference between dominance and codominance class 12 anatomy is essential when performing cardiac surgery such as a coronary bypass.
Coronary angiography is a minimally invasive method used to evaluate the anatomy and obtain different measurements of the coronary arteries. Difference between dominance and codominance class 12 study was designed to evaluate the endoluminal diameter, trunk length and anatomical distribution of coronary arteries in Chilean subjects without apparent angiographic lesions. Ostium and the distal luminal segments diameters were measured, as well as trunk length of both right and left coronary arteries.
Ostium of the anterior interventricular artery, dominance and tortuosity were also registered. In the right coronary artery, the diameters 3. In the left coronary artery, the diameters 4. The left coronary artery showed greater diameters and length than the right coronary artery. The prevalence of right arterial dominance was Significant arterial tortuosity was observed in seven subjects.
La angiografía coronaria es un método mínimamente invasivo que se utiliza para evaluar la anatomía y obtener diferentes medidas. Las mediciones fueron realizadas en sujetos chilenos de ambos sexos con un rango etario entre 45 a 78 años. En siete sujetos se observó una tortuosidad arterial significativa. The disease also has a significant impact in developing countries Zhu et al.
This unique disparity with the rest of the country has not been researched, although specific aspects of coronary artery anatomy may play a role. Information about the morphology, length and lumen diameters in normal healthy coronary arteries is scarce. Nevertheless, thorough knowledge and understanding of these parameters is critical.
Indeed, coronary artery dimensions may vary based on sex, age, and ethnicity as well as body surface area and body weight Leung et al. Thus, interventional cardiac procedures and factors adjusted for age, sex, body surface area and ethnicity, in small populations as is the case of this study, may be useful for comparison with other populations. Skowronski et al.
In recent years, the biometric characteristics of coronary arteries in particular countries or ethnic groups, have been studied and compared with other populations i. India, Turkey or Iraq Shukri et al. However, to our knowledge there are no studies regarding normal anatomical characteristics of coronary arteries in the Chilean population.
Currently, coronary angiography CA is considered the gold standard and an essential technique to evaluate these arteries, despite the potential risks such as ionizing radiation, invasiveness and a small associated risk of morbidity Wielopolski et al. On the other hand, since visual estimation of arterial stenosis may vary between operators, automated measurement systems have been introduced.
In a recent study Sen et al. They concluded that visual assessment may overestimate a coronary lesion and thus lead to unnecessary interventions. Therefore, automated systems have been developed can a teacher fall in love with student accurately evaluate normal and pathologic morphology in coronary arteries and avert needless procedures.
The present study was designed to evaluate length and endoluminal diameter of selected segments of coronary arteries and their main branches. The analysis was carried out in a sample of Chilean subjects without coronary angiographic lesions, residing in an area with difference between dominance and codominance class 12 rates of coronary disease. It is proposed that the study may serve as a baseline for comparison with other populations, and establish clinical standards for procedures in accordance with the characteristics of local patients.
This is a retrospective clinical study in a sample of patients who were referred to the hospital with symptoms of coronary heart disease, between and Diagnosis revealed no significant angiographic lesions. Respecting their anonymity, baseline clinical difference between dominance and codominance class 12 of patients, socio demographic information and other data were obtained for participating subjects. The selection of patients did not consider co-morbidity.
The exclusion criteria were those proposed by Leung et what does the name david mean in english. After applying inclusion and exclusion criteria the final sample consisted of patients. At RCA the following measurements were performed: e. At LRA the measurements were: e.
Angiographic images meeting the pre-established inclusion and exclusion criteria were used for calibration, and results obtained by an expert were considered as reference values. Reliability of biometric analyses was calculated for inter- and intra-examiner values using infraclasses correlations ICC giving an average value of Thereafter, a descriptive analysis of the sample obtained was performed according to sex, age over 61 years and under 62 years and dominance right; left, excluding the codominance of bivariate analysis, since it occurred in two subjects only.
Central trend and dispersion measures were obtained from all measurements. Statistical analysis. To compare the average measurements t-test were performed for independent samples, and Mann- Whitney U test, selected according to the normality obtained in the data distribution. Wilcoxon signed rank W test was used to compare paired samples. Furthermore, the ostium difference between dominance and codominance class 12 and end-trunk diameter of both arteries were related visually related by point graph and statistically by Pearson correlation test.
A total of subjects were initially recorded, however patients were excluded for not meeting the inclusion criteria, and 2 were excluded for showing statistically extreme values. Therefore, the final number of subjects studied was individuals. Most of the patients were male For right coronary arteries Table I the average value at R1 was 3. Moreover, statistically significant differences were observed between sexes, with higher average values in males 3. For the right trunk length R2 average value was The end-trunk diameter R3 averaged 3.
Males had a thicker caliber relative to women 3. B Measurement in RCA, the right marginal branch main is observed originates in the middle third of the right coronary artery right at the measurement endpoint. There are also some marginal vessels that emerge from the main trunk regarded as minor marginals vessels. The absence of minor marginal branches makes measurement easier end- to-end pointed lines define arterial trunk length.
D Measurement at L1 in a left coronary artery with a slight angulation nasty meaning in tagalog note the visibly decreased gauges. E Measurement at L3, where the pointed line is observed to detect a diameter of 5. F Measurement at L4. Note that there is a distance of 1. In some cases, the exact distance 2 mm from the start of the anterior ventricular branch cannot be obtained.
The discontinuous line shows a diameter of 2. Table I Summary of mean values of biometric measures performed in the coronary arteries. Note: Numbers may not round due to missing values. For left coronary arteries, ostium diameter L1 indicated an average value of 4. Length of the arterial trunk L2 and lumen at the end of the trunk L3 showed on average, values of 7.
Lumen diameter at the end-trunk of the artery L3 was 4. The same was true for the diameter of the anterior interventricular artery L4 which had an average value of 3. Regarding tortuosity factor, 7 subjects were considered sinuous, and the average values of end-trunk diameters statistically differed between right and left arteries 3. Linear relationship between the left and right ostium of difference between dominance and codominance class 12 coronary arteries.
Linear relationship between the end-trunk caliber. A retrospective imaging study was conducted through coronary angiography, using Seldinger's radial technique in a sample of patients that meet the inclusion and exclusion criteria. To our knowledge no similar studies have been carried out locally in a Chilean population. The size of the sample and internal characteristics of the group age and sex distribution give rise for comparison of these results with previous studies.
These may be considered proportionate in relation to studies published in smaller population samples in the past Leung et al. These studies demonstrate difference between dominance and codominance class 12 reduced caliber of the left main trunk, anterior ventricular branch, circumflex branch and right trunk in Asian-Indian subjects compared to the North American Caucasian population Makaryus et al.
These results coincide with Vieweg et al. It should be noted however, that they did not take into consideration demographic factors. For instance, ethnicity, dominance, tortuosity or cardiovascular risk, all of which can influence the biometric values of coronary arteries Makaryus et al. An interesting finding in our study was that the endoluminal measurement of both coronary arteries varies parallelly. To our knowledge, this observation is being reported for the first time.
Further studies are necessary to elucidate the relevance of these findings. This lends support to the studies by Vaccarino et al. Though this may be the result of ungrouped data from various ethnic populations, and the evidence presented involving scarce number of studies that compare white and Asian-Indian subjects. It is worthwhile mentioning the limitation between the various ethnic population comparison studies, since they use different measurement points in each arterial branch.
With respect to coronary dominance Interestingly, subjects with right dominance showed an average caliber at end-trunk greater than those with left dominance. It has also been reported that the ending lumen of the left coronary trunk and the anterior interventricular branch are not affected by dominance Dodge et al. Right trunk length was significantly longer 3. Nevertheless, the length of the left arterial trunk did not change in relation to sex, age or dominance. Since it was present in 3.
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