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Vol. 69. Issue 4.
Pages 460-461 (April 2016)
Letter to the Editor
DOI: 10.1016/j.rec.2016.01.005
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Could Descending Septal Artery Be Another Variant of the Dual Left Anterior Descending Artery? Response
¿Podría ser la arteria septal descendente otra variante de la doble arteria descendente anterior? Respuesta
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José M. Montero-Cabezas
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J.M.Montero_Cabezas@lumc.nl

Corresponding author:
, Victoria Delgado, Ioannis Karalis, Martin J. Schalij
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Rev Esp Cardiol. 2016;69:458-6010.1016/j.rec.2015.12.016
Francisco L. Moreno-Martínez, Hugo Spindola-Franco, Omaida J. López-Bernal
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To the Editor,

We thank Moreno-Martínez et al for their comments regarding our letter.1 As they mention, the incidence of dual left anterior descending artery in healthy hearts is approximately 1%. Although the true incidence of descending septal artery based on coronary angiographic findings is unknown, its presence has been detected in a surprisingly high percentage of postmortem studies. Rodríguez et al2 identified the descending septal artery in 12% of 427 specimens; Taylor,3 in 68% of 112; and Sahni and Jit,4 in 85% of 500 autopsy subjects. As we stated in the above-mentioned letter, this could be explained by the high perfusion pressures used during these studies (reaching 280mmHg) and the loss of muscle tone, or by the absence of surrounding tissue, which would facilitate the visualization of this vessel.5

This high detection rate, in contrast to the 1% reported for dual left anterior descending artery, could indicate that the descending septal artery is an anatomical variant that is underdetected by conventional angiography, rather than a coronary artery anomaly per se. Its development appears to be more evident in the presence of obstructive coronary artery disease,5 suggesting the “recruitment” of descending septal artery as a source of collateral circulation (Figure).

Figure.

Anterior descending septal artery (arrows), which provides homocoronary collateral circulation (arrow heads) toward distal right coronary artery in the presence of an acute occlusion (A) and chronic occlusion (B) of right coronary artery.

(0.08MB).

We agree with Moreno-Martínez et al in the need for an adequate assessment of the descending septal artery, taking into account its potential role in certain clinical scenarios.

References
[1]
J.M. Montero-Cabezas, A.M. Tohamy, I. Karalis, V. Delgado, M.J. Schalij.
La arteria septal descendente: descripción de esta variable anatómica poco frecuente en tres escenarios clínicos diferentes.
Rev Esp Cardiol., 68 (2015), pp. 1029-1031
[2]
F.L. Rodríguez, S.L. Robbins, M. Banasiewicz.
The descending septal artery in human, porcine, equine, ovine, bovine and canine hearts. A postmortem angiographic study.
Am Heart J., 62 (1961), pp. 247-259
[3]
J.R. Taylor.
The descending septal artery: its relation to the conduction system of the heart.
Arch Pathol Lab Med., 104 (1980), pp. 599
[4]
D. Sahni, I. Jit.
Blood supply of the human interventricular septum in North-West Indians.
Indian Heart J., 42 (1990), pp. 161-169
[5]
M. Said, V.A. Mühlberger.
The descending septal branch (Bonapace's branch). A case report and literature review of this often forgotten branch. First description in vivo.
Eur Heart J., 16 (1995), pp. 1443-1447
Copyright © 2016. Sociedad Española de Cardiología
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