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In this first case, we're going to review a patient

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with a right dominant coronary circulation.

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So I'm going to scroll through on the axle images and just describe

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what we see.

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So first we get into the left main Corner artery and

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you can see that you have the left main. This is an LED here

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and this is a circumflex coming off.

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One note when you're reviewing coronary CT you want to make sure the window

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so that you can see the texture inside the

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Lumen if you window too bright,

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then you lose that sort of pixelated texture and

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that can obscure lesions. So for instance, this patient has some some

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small classified blacks here in the LED that are

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really kind of tough to see when your window is set

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in the wrong setting and a little too narrow.

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So you want to make sure the window a little wide so you

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can see the texture of the Noise Within

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the vessel itself and that allow you a chance to see things

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like these little bits of calcium.

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Here and here and also here in the circumflex. So

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there's that led. There's the certain Flex that both

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decent sized vessels. You can see a diagonal Branch here.

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And then as we head down lower we're gonna get into the right corner artery. So

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this is an example of a right dominant system. So

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what things expect to see for right dominant system. Well

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one thing you'll see are the first couple of branches

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off the right corner artery the right coronary usually

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has two branches that are the first things and they

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kind of go back and forth which ones first in

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this particular patient. You see the conus branch

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coming off first. That's this guy here.

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It's a branch that comes high off of the right corner artery and then

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sends branches to supply this area

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of the right ventricle here called the conus.

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In this case the conus branch actually continues down along the free

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wall of the RV and continues and sort of an acute marginal

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territory, which is just a variant.

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There's also this Branch here. This is the AV nodal

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branch, which has posteriorly this Branch.

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Most of the time comes from the right corner artery, although occasionally. You

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can see it in about 30 to 40% of people coming off

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of the circumflex.

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Here and running in this direction. So this particular patient has

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a Avi nodal Branch from the right

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coronary artery.

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As we head downward, we're going to see some smaller branches off

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the right cornering like you see there and there these are

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acute marginal branches.

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In general when we're assessing for coronary stenosis.

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We don't really pay a whole lot of attention to the acute marginal branches.

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It's very rare to see any significant disease in

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those branches and in general. They're not usually targets

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for revascularization.

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Then we scroll down lower we get into this most distal part of

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the right corner artery.

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And from the distal right corner artery comes the

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PDA and the posterolateral branches

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or the posterior left ventricular branches.

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Terms are used interchangeably in the literature.

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Plb is posterior lateral branch plv, which

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would be posterior less ventricular branch?

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So here's the PDA. That's the first branch that comes

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off and runs in this posterior interventricular group. It's a

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nice size vessel here.

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And then you can see there's a bunch of other little branches. So one there

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one there and then a larger one here. These

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are all considered posterior LV branches

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or posterolateral branches that all Supply

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the inferior wall of the left ventricle. And these can

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be important the PDA for sure can be the

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cause of significant ischemia and can

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be a target for revascularization in the

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same goes for the plb if it's a big enough vessel, so you

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certainly want to pay attention to disease in these regions.

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In patients at the right dominant system. So just to

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sum up the presence of both the PDA and poster lateral

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branches tell you that it's a right dominant system.