Is there hemodynamic advantage for co-dominant coronary circulation ?

Co-dominant coronary  circulation is defined as , when  posterior crux of the heart receives twigs from both right and left system making this water shed area with advantage of twin innervation.They essentially supply  inferior and posterior aspect of both left and right ventricle including the posterior aspect of interventricular septum. Image courtesy modified from :http://www.meddean.luc.edu/lumen/meded/mech/cases/case1/image4.JPG Traditionally inferior and basal aspects of heart are perceived (wrong tough !) as less important  than anterior  surface of heart.Infero posterior MI can be extensive and cause significant LV dysfunction and poor outcome. Longitudinal function (AV grooval velocity) and Mitral valve function  is critically  dependent on  posterior circulation. Is there an advantage for co-dominant circulation  with reference to ischemic mitral regurgitation ? Obviously ,one would expect there is some advantage in co-dominant circulation when ACS occurs  either LCX or RCA.It could theoretically  protect against development of MR as posterior  papillary muscles could receive supportive twigs from its companion. However , there is a caveat .The antero-lateral papillary muscle normally has twin blood  supply from LAD(Diagonal ) and LCX (OM) . But in co-dominant circulation this pap muscle is  at risk of becoming single blood supply as the dominant RCA has a trade off with OM with its large PLV branch. It is likely in   co-dominant circulations if LAD ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized Source Type: blogs