Blood Supply of the Right Ventricle

Right Ventricle OutlineAnatomy of the Right VentricleBlood Supply of the Right Ventricle2D Views of the Right Ventricle - Part 12D Views of the Right Ventricle - Part 2Doppler Evaluation of the Right VentricleRight Ventricular Failure - Part 1Right Ventricular Failure - Part 2Right Ventricular DilationRight Ventricular HypertrophyRight Ventricular Diastolic DysfunctionRight Ventricle SummaryCME and Self Assessment Exams

Blood Supply

Coronary Dominance (PDA Supply)	SA Node Supply	AV Node Supply
RCA 70%	RCA 59%	RCA 90%
Cx 10%	Cx 38%	Cx 10%
Both 20%	Both 3%

The right ventricular free wall is subdivided into basal, mid and apical segments and is supplied by the right coronary artery (RCA).

The posterior descending artery (PDA) supplies the posterior 1/3 to 2/3 of the interventricular septum, but not the apex of the heart. The PDA is supplied by the RCA in 70% of patients, the circumflex artery (Cx) in 10% of patients, and both in 20% of patients. The supply of the PDA determines the dominance of the coronary arterial system. A small anterior section of the right ventricle may be supplied by the conus branch of the left anterior descending artery.

The mid segment of the septum can be supplied by the right coronary artery (RCA) or the left anterior descending artery (LAD). The apical segment of the septal wall is supplied by the left anterior descending artery (LAD).


Right Coronary Artery	Coronary Artery Key	Left Anterior Descending Artery

		SN = Sinus Node RV = Right Ventricle AM = Acute Marginals RCA = Right Coronary Artery PL = Posterolateral PD = Posterior Descending OM = Obtuse Marginals Cx = Circumflex OM = Obtuse Marginals S = Septal Perforators D = Diagonals LAD = Left Anterior Descending RAO = Right Anterior Oblique
	Right Dominant Co-Dominant Left Dominant

The RCA also supplies the sino-atrial (SA) node in 59% of cases. The SA node is supplied by the circumflex (Cx) coronary artery in 38% of cases and dual blood supply by the RCA and Cx in 3% of cases. The AV node is supplied by the RCA 90% of cases and by the Cx in 10% of cases

The blood supply to the right ventricle occurs during systole and diastole. The peak pressures of the normal right ventricle are less than the diastolic blood pressure, therefore flow to the right ventricular myocardium occurs during diastole and systole.

Air and Emboli

The right coronary artery ostium is located anteriorly and is subject to air and atheromatous embolic, especially during the weaning process of extracorporeal circulation. The vein grafts are also frequently located anteriorly and are subject to air and atheromatous emboli.

Cardioplegia

Retrograde cardioplegia does not typically supply adequate protection of the right ventricle. The right ventricle is located anteriorly and is subject to the warming effect of the operating theatre lights.