What area of the heart is supplied by the Right Posterior Descending Artery (RPDA)?

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Last updated: January 27, 2026 • View editorial policy

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Right Posterior Descending Artery (RPDA) Territory

The Right Posterior Descending Artery (RPDA) supplies the posterior one-third of the interventricular septum via septal perforator branches, and contributes to the inferior wall of the left ventricle in right-dominant circulation. 1

Primary Anatomical Territory

The RPDA has a well-defined anatomical distribution:

  • The RPDA runs in the posterior interventricular groove and supplies septal perforator branches that perfuse the posterior third of the interventricular septum 1, 2

  • In right-dominant circulation (approximately 90% of individuals), the RPDA arises from the right coronary artery and contributes to blood supply of the inferior wall of the left ventricle 1, 3

  • The posterior descending septal perforators originating from the PDA are the specific vessels that deliver blood to the septal tissue 1

Relationship to Coronary Dominance

Understanding coronary dominance is critical for interpreting RPDA territory:

  • Right dominance (90% of cases): The PDA and posterolateral artery (PLA) both arise from the RCA, making the RPDA the primary supplier to the inferior septum and inferior left ventricular wall 1, 3

  • Co-dominant circulation: The RCA supplies the PDA while the circumflex supplies the PLA, meaning both vessels contribute to inferior wall perfusion 1

  • Left dominance (10% of cases): The PDA arises from the left circumflex artery rather than the RCA, so there would be no "RPDA" in these patients 1

Clinical Significance

The RPDA territory has important clinical implications:

  • Occlusion of the RPDA can result in inferior wall myocardial infarction and posterior septal involvement, which may lead to ventricular septal rupture (VSR) occurring in 1-2% of all myocardial infarctions with 54% mortality in the first week without surgery 2

  • The posterior septal perforators from the PDA are targets for alcohol septal ablation in hypertrophic cardiomyopathy, where 1-3 cc of ethanol creates controlled septal infarction 2

  • Anatomic variants exist where the PDA may be duplicated or arise from anomalous sources (such as continuation of LAD around the apex), which can complicate surgical planning 4, 5, 6

Important Caveats

  • The extent of RPDA territory varies based on the length of the vessel - a short PDA supplies less septal territory, while a long PDA may extend further toward the apex 7

  • The posterior right diagonal artery (PRDA), when present in 15% of right-dominant systems, may also perfuse the inferior posterior septum, particularly when the PDA is short 7

  • Always verify coronary dominance before attributing specific territory to the RPDA, as anatomic variants can significantly alter the expected perfusion patterns 8, 5, 6

References

2
Guideline

Blood Supply to the Ventricular Septum

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

Right Coronary Artery Supply to the Heart

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.