Anatomical variations of the coronary perfusion as a basis of myocardial vulnerability to coronary artery occlusion

The aim of this study is to determine the anatomical explanation for the greater or lesser vulnerabilities of the left ventricular segments in the event of occlusion of each of the main coronary arteries. To this end, we analyzed the arterial perfusion of 1,080 left ventricular segments from 90 human hearts obtained at autopsy. Post‐mortem angiography, dissection, and constriction of an arterial map using the classification of Selvester et al. (1982) were applied. By careful monitoring of the arterial perfusion of each segment we conclude that (1) obstruction of the anterior interventricular artery (AIV) especially affects the superomesial, superoapical, and anteroapical segments; (2) obstruction of the circumflex artery (CX) especially affects the posterobasal and posteromesial segments; and (3) obstruction of the right coronary artery (RC) especially affects the inferobasal and inferomesial segments. Vulnerability of the myocardially segments decreases in those segments which have collateral supply, i.e., those which are only relatively dependent upon a particular coronary artery. © 1994 Wiley‐Liss, Inc. Copyright © 1994 Wiley‐Liss, Inc.