Anomalous course and branches of human coronary arteries

132 hearts obtained from cadavers were dissected in order to study anomalies in the course and branches of human coronary arteries. Only in 1 heart was a deviation of the circumflex branch of the left coronary artery taking a course inferior to the coronary sulcus observed. The right coronary artery travelled the entire length of the coronary sulcus on the back of the heart and gave both a posterior ventricular and a collateral branch. Circumflex branches of the right and left coronary arteries did not anastomose.     

猪冠状动脉的解剖学观察

本文对50例健康的商品猪心脏的铸型标本进行了观察,结果如下:左冠状动脉旋枝与锥旁室间枝的夹角为74.4±2.07度。对角枝出现率为24％,并证明了对角枝出现率与其夹角大小呈正比关系。窦房结枝84％来自右冠状动脉。房室结枝98％来自右冠状动脉。左房旋枝出现率为8％。室间隔的供血由锥旁室间枝的分枝负担61％,约为3/5,窦下室间枝的分技负担39％,约为2/5。室上嵴技、Kugel动脉、室间隔中枝和室间隔背倒前枝的出现率分别为78％、20％、68％和28％。心尖区的血液由左、右冠状动脉共同供应。50例左、右冠状动脉始部外径之比为1.2∶1。左、右冠状动脉在心膈面的分布类型以右强型为主。本文还讨论了猪冠状动脉与狗、人冠状动脉的异同。     

Incidence of anomalous origin of coronary artery in 1879 Chinese adults on dual-source CT angiography

Background and Objective. Dual-source CT (DSCT) has been used to detect coronary artery anomalies. The purpose of this study was to assess the incidence of anomalous origin of the coronary artery in Chinese adults. Methods. We summarised all patients who underwent DSCT coronary angiography (CTCA) from December 2006 to February 2008, and data of anomalous origin of the coronary artery in Chinese adults were recorded. Results. 1879 patients underwent CTCA during that period; 24 patients with an anomalous origin of the coronary artery were detected, giving an incidence of 1.3%. Fifteen patients had an anomalous origin of the right coronary artery (12 from left coronary sinus, 3 high takeoff), eight patients had an anomalous origin of the left coronary artery (LCA from posterior sinus of Valsalva in three cases, LCX from the right coronary sinus, LCX from RCA, high takeoff, LCA from right coronary sinus, and single coronary artery in one case, respectively), and one patient had an anomalous origin of both coronary arteries (high takeoff). Conclusion. The incidence of anomalous origin of the coronary artery in Chinese adults in this study is 1.3%. DSCT can clearly visualise the anomalous origin and course of the coronary artery and is a useful screening modality. (Neth Heart J 2010;18:466-70.)     

Blood Supply to the Interventricular Septum of the Heart in Rodents with Intramyocardial Coronary Arteries

The blood supply to the interventricular septum of the heart was studied in a sample of 1634 specimens belonging to four rodent families, Cricetidae, Arvicolidae, Gliridae, and Muridae. Most specimens (n = 1604) were examined using a corrosion-cast technique, while the remaining 30 were studied by histological techniques. In 1417 cases the coronary artery pattern was normal, and the interventricular septum was fundamentally supplied by one or rarely two septal arteries arising from the right and/or left coronary arteries. In 72 specimens the right and left coronary arteries were normal, while the septal artery arose from a separate ostium in the aorta, behaving as a third coronary artery. The remaining 145 animals possessed anomalies in the origin of the coronary arteries, and the septum was also principally irrigated by a septal artery. In 5 of these 145 anomalous cases the septal artery originated from a separate ostium in the aorta. In all specimens examined a less important vascularization of the septum was established through thinner penetrating vessels originating from the right and/or left coronary arteries. Existence of one or rarely two septal arteries is the most constant feature of the coronary artery arrangement in rodents with intramyocardial coronary arteries.     

Vascularization of the conducting system in the human heart

On 200 randomized specimens of the human heart, of either sex, from 20 to 80 years of age, we investigated the vascularization of the conducting system of the heart in relation to the type of coronary ramification, by the dissection, injection-corrosive, radiographic and coronarographic method. The symmetrical type of arterial vascularization was established in 24%, the right type in 63% and the left type in 13% of the cases investigated. The sinoatrial node is vascularized in 60% by the right and in 40% of the cases by the left coronary artery. The atrioventricular node and the stem of the atrioventricular bundle are vascularized by the right coronary artery in 85% of the cases investigated, in 13% by the left and in 2% by both arteries. The right fasciculus of the atrioventricular bundle is vascularized by the left artery, the left fasciculus by both arteries. The vascularization of the posterior strand in both ventricles is conformable to the type of arterial vascularization of the heart.     

Distributing and delivering vessels of the human heart

The branching characteristics of the right coronary artery, acute marginal, posterior descending, left anterior descending, circumflex, and obtuse marginal arteries are compared with those of diagonal branches, left and right ventricular branches, septal, and higher-order branches, to test a newly proposed functional classification of the coronary arteries in which the first group rank as distributing vessels and the second as delivering vessels. According to this classification, the function of the first type is merely to convey blood to the borders of myocardial zones, while the function of the second is to implement the actual delivery of blood into these zones. This functional difference is important in the hemodynamic analysis of coronary heart disease, as it provides an assessment of the role of a vessel within the coronary network and hence an assessment of the functional importance of that vessel in a particular heart. Measurements from casts of human coronary arteries are used to examine the relevant characteristics of these vessels and hence to test the basis of this classification.     

Right Internal Mammary Artery Implantation into Right Ventricular Myocardium for Revascularization of the Entire Heart: Experimental Data and Preliminary Report

The left internal mammary artery implant combined with epicardiectomy and free omental graft provides three extra-coronary sources of blood. This operation tested in dogs with 92% main-stem occlusion of three coronary arteries protected 75% of the animals. Applied clinically in over 100 patients, the operation resulted in 90% improvement. To obtain complete myocardial revascularization, the right internal mammary artery has been used as a fourth source of extra-coronary blood. In 57 animals, the right internal mammary arteries were implanted into the anterior walls of the right ventricle; in 80% this vessel formed anastomoses with the right coronary tree, and in 65% with the right and left coronary arteriolar systems. Six patients are described who underwent right internal mammary artery implantation; five of these in addition had the combined operation of left internal mammary artery implant, epicardiectomy and free omental graft. All patients had completely blocked right coronary arteries; in addition, five had advanced disease of the left coronary arterial tree.     

Anomalous right coronary artery originating from the left sinus of Valsalva in a Yucatan minipig

A 39.2-kg, castrated male Yucatan minipig (Sus scrofa domestica) was presented for enrollment in a coronary artery study. Angiography revealed an anomalous right coronary artery originating from the left sinus of Valsalva. The left anterior descending, left circumflex, and anomalous right coronary arteries were implanted with metallic stents without complications. The minipig remained on the study for 3 mo until it reached its predetermined study endpoint, during which time it showed no clinical signs of disease. Histologic examination of the implanted coronary arteries revealed no differences between the normal (left anterior descending and left circumflex arteries) and the anomalous right coronary artery. Swine are important models for coronary research. Although several cases of anomalous human coronary arteries have been documented, the current case is the first report of a coronary artery anomaly in a minipig.     

Transcatheter aortic valve implantation and hybrid coronary artery revascularization: time to combine them

We report on simultaneous off-pump coronary artery bypass grafting to the left anterior descending artery, modified transapical aortic valve implantation, and stenting of the circumflex and right coronary arteries in an 84-year-old patient. The poly-morbid patient with a logistic EuroSCORE of 85% experienced recent myocardial infarction; the left ventricular ejection fraction was reduced to 20%. Postoperative recovery was fast and short. The strategy described is the next logical step in broadening the indication for transcatheter aortic valve interventions.     

The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

BackgroundCurrent guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course.AimTo provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries.MethodsA clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained.ResultsPrimary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated.ConclusionsStructural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.Supplementary InformationThe online version of this article (10.1007/s12471-021-01556-9) contains supplementary material, which is available to authorized users.     

Scaling of myocardial mass to flow and morphometry of coronary arteries.

There is no doubt that scaling relations exist between myocardial mass and morphometry of coronary vasculature. The purpose of this study is to quantify several morphological (diameter, length, and volume) and functional (flow) parameters of the coronary arterial tree in relation to myocardial mass. Eight normal porcine hearts of 117-244 g (mean of 177.5 +/- 32.7) were used in this study. Various coronary subtrees of the left anterior descending, right coronary, and left circumflex arteries were perfused at pressure of 100 mmHg with different colors of a polymer (Microfil) to obtain rubber casts of arterial trees corresponding to different regions of myocardial mass. Volume, diameter, and cumulative length of coronary arteries were reconstructed from casts to analyze their relationship to the perfused myocardial mass. Volumetric flow was measured in relationship with perfused myocardial mass. Our results show that arterial volume is linearly related to regional myocardial mass, whereas the sum of coronary arterial branch lengths, vessel diameters, and volumetric flow show an approximately 3/4, 3/8, and 3/4 power-law relationship, respectively, in relation to myocardial mass. These scaling laws suggest fundamental design principles underlying the structure-function relationship of the coronary arterial tree that may facilitate diagnosis and management of diffuse coronary artery disease.     

Sudden unexpected death in children with congenital heart disease.

Of 18,000 children with organic heart disease evaluated at The Hospital for Sick Children, Toronto between 1940 and 1971, 33 died suddenly and unexpectedly between 1 and 21 years of age. Nine had discrete obstruction of the left ventricular outflow tract and five had muscular narrowing of the left ventricular outflow tract and five had muscular narrowing of the left ventricular outflow tract. Pulmonary vascular disease caused seven sudden deaths, and arrhythmias (usually due to atrioventricular block) caused seven more. Of the five other children who died suddenly three had transposition of the great arteries, one had a complex cyanotic heart defect and one had an anomalous course of the left coronary artery, which originated from the right sinus of Valsalva. With earlier investigation of aortic stenosis, earlier closure of ventricular septal defect to avoid pulmonary vascular disease, better design of artificial pacemakers and better investigation of patients with angina, many of these deaths will be avoided in the future.     

Age-Related Changes of Elements in the Coronary Arteries of Monkeys in Comparison with Those of Humans

To elucidate compositional changes of the coronary artery with aging, the authors investigated age-related changes of elements in the coronary arteries of rhesus and Japanese monkeys by direct chemical analysis in comparison with the coronary arteries of Japanese and Thai. Used monkeys consisted of 38 rhesus monkeys and 23 Japanese monkeys, ranging in age from newborn to 33 years. After perfusion with a fixative, the hearts were resected from the monkeys, and the anterior interventricular branches of the left coronary artery and the right coronary arteries were resected from the hearts. After ashing of the arteries, element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that the Ca and P contents did not increase in both the left and right coronary arteries of rhesus and Japanese monkeys at old age. The average contents of Ca and P decreased by 13% and 25% in the left coronary arteries more than 20 years of age in comparison with those below 20 years of age, whereas they decreased by 4% and 15% in the right coronary arteries more than 20 years of age in comparison with those below 20 years of age. This finding indicated that atherosclerosis scarcely occurred in both the left and right coronary arteries of rhesus and Japanese monkeys at old age. In contrast with monkeys, atherosclerosis occurred frequently in the coronary arteries of Japanese and Thai at old age.     

金钱豹和猪獾冠状动脉的解剖

为了阐明金钱豹(Panthera pardus)和猪獾(Arctonyx collaris)心冠状动脉的分支分布特征及血供情况,为心脏生物学及动物学研究提供结构基础资料,利用血管铸型和组织透明方法观察研究了金钱豹与猪獾心左、右冠状动脉的分支分布.结果表明,金钱豹和猪獾的心均由左右冠状动脉营养.金钱豹左冠状动脉分为室间隔支、前降支和旋支.前降支又分出左室上支、左室中支和左室下支.右冠状动脉沿途分出右室前支、右室后下支和右室后上支.猪獾左冠状动脉分为前降支和旋支.前降支又分出室间隔支和左室前支,旋支又分出左缘支和左室后支.其右冠状动脉沿途分出右室前支、右缘支和右室后支.金钱豹和猪獾心的室间隔均由发自左冠状动脉的独立的室间隔支营养,二者左右冠状动脉在膈壁的分布属于均衡型.     

Catheter-based antegrade intracoronary viral gene delivery with coronary venous blockade

The purpose of this study is to evaluate the feasibility of percutaneous antegrade myocardial gene transfer (PAMGT). A consistent and safe technique for in vivo gene transfer is required for clinical application of myocardial gene therapy. PAMGT with concomitant coronary venous blockade was performed in 12 swine. The myocardium was preconditioned with 1 min of occlusion of the left anterior descending and left circumflex arteries. The anterior interventricular vein was occluded during left anterior descending artery delivery, and the great cardiac vein at the entrance of the middle cardiac vein was occluded during left circumflex artery delivery. With arterial and venous balloons inflated (3 min) and after adenosine (25 mug) injection, PAMGT was performed by antegrade injection of an adenoviral solution (1 ml of 10(11) plaque-forming units in each coronary artery) carrying beta-galactosidase or saline through the center lumen of the angioplasty balloon. In one set of animals, PAMGT was performed with selective coronary vein blockade (n = 9); in another set of animals, PAMGT was performed without coronary vein blockade (n = 5). At 1 wk after gene delivery, the animals were killed. Quantitative beta-galactosidase analysis was performed in the left and right ventricular walls. PAMGT was successfully performed in all animals with and without concomitant occlusion of the coronary veins. Quantitative beta-galactosidase analysis showed that PAMGT with coronary blockade was superior to PAMGT without coronary blockade. beta-Galactosidase activity increased significantly in the beta-galactosidase group compared with the saline group: 1.34 +/- 0.18 vs. 0.81 +/- 0.1 ng (P 相似文献   

The Continuity of Right and Left Ventricular Myocardial Sinusoidal Spaces and its Relation to Right Ventricular Implants

Evidence is presented which indicates that blood leaving side branches of an internal mammary artery implanted into the anterior wall of the right ventricle flows from the tunnel in which it lies through myocardial sinusoidal spaces of the anterior right ventricular wall across the midline to fill corresponding spaces in the anterior wall of the left ventricle and thence is carried to the left coronary sinus. The myocardial sinusoidal spaces of right and left ventricles have been well outlined, using injections of polyvinyl acetate and the technique of digestion casts. We have been able to show that there is no barrier between the myocardial sinusoids of the right circulation and those related to the anterior descending branch of the left coronary artery. In structure, these myocardial sinusoidal spaces are quite different from the intramyocardial coronary arteriolar zones which, in 93% of human hearts, are separated from one another without collateral communication.The continuity of the right and left ventricular myocardial sinusoids explains why implantation of a right internal mammary artery into the anterior wall of the right ventricle combined with a corresponding left implant, epicardiectomy and free omental graft, has been so effective in our hands in the treatment of far-advanced human coronary artery insufficiency.     

Progression of coronary atherosclerosis relates to the onset of myocardial infarction in an animal model of spontaneous myocardial infarction (WHHLMI rabbits).

Recently, we developed myocardial infarction-prone WHHLMI rabbits from coronary atherosclerosis-prone WHHL rabbits (WHHLCA rabbits) by selective breeding. In this study, we examined the relation of atherosclerotic plaques to the onset of myocardial infarction. We examined myocardial lesions of 378 WHHL rabbits born between 1992 and 2000, and atherosclerosis lesions of 93 WHHLCA and 82 WHHLMI rabbits. The aortic lesions were evaluated as percent surface lesion area. The coronary lesions were evaluated as cross sectional narrowing using sections prepared at 500 or 1,000 microm intervals. Serum lipid levels were assayed with enzymatic methods. The cumulative incidence of fatal myocardial infarction between 11 and 35 months old was 90% in WHHLMI rabbits and 21% in WHHLCA rabbits, respectively. Selective breeding increased the serum cholesterol levels by about 200 mg/dl despite there being no changes in triglyceride levels. Aortic and coronary atherosclerosis progressed markedly in WHHLMI rabbits compared to WHHLCA rabbits. Especially, WHHLMI rabbits over 15 months old showed more than 90% cross sectional narrowing of the left circumflex arteries, main stem of the left coronary artery, and the origin portion of the right coronary artery. In addition, there were no gender differences in atherosclerotic lesions of both aortas and coronary arteries. In conclusion, the present study showed that marked progression of coronary atherosclerosis was probably associated with spontaneous development of myocardial infarction in WHHLMI rabbits.     

Quantification of Blood Supply to the Left Ventricular Myocardium in Normal Subjects and Patients with Coronary Heart Disease

The subjects who underwent diagnostic coronarography and detailed examination included 274 patients with lesions in the left coronary artery and its branches and 50 subjects without pathological changes in the coronary arteries or left ventricle. The authors also examined 149 patients with unchanged coronary arteries (67 with small vessel disease 42 with cardiomyopathy of various etiology; and 40 with other pathologies, such as the WPW syndrome, arterial hypertension, aortic stenosis, etc.). In addition to routine retrograde left heart catheterization and recording of the hemodynamic parameters demonstrated by ventriculography, the coronary blood flow was measured in all patients. Its normalized (specific) values are a basis for the coronary blood flow quantification in normal subjects, patients with the coronary heart disease (with insufficient oxygen supply to the myocardium), and those with cardiomyopathy of various genesis (when the myocardial oxygen demand increases together with the left ventricular myocardium mass).     

NEGATIVE TREADMILL EXERCISE TEST RESULT WITH SUBSEQUENT MYOCARDIAL INFARCTION AND CORONARY ARTERY BYPASS: CASE REPORT

Myocardial infarction is a rare complication of maximal exercise testing.(1) In the case presented here, infarction occurred in a 54-year-old man, 14 minutes after he showed a normal response to maximal multistage treadmill exercise testing. The presence of coronary artery disease had been documented angiographically prior to exercise testing. After infarction, the patient underwent emergency double aortocoronary bypass to the left anterior descending and right coronary arteries with good results. Clinical evidence suggests that the extent of myocardial necrosis was reduced by timely surgical intervention. There is no conclusive explanation for this patient's normal response to maximal exercise testing in the presence of advanced coronary artery occlusive disease followed rapidly by infarction. The value of exercise testing is well established in assessing the existence or severity of coronary artery disease; a normal response, however, cannot be used as an infallible indication that critical coronary artery disease does not exist.     

Exercise training improves endothelium-mediated vasorelaxation after chronic coronary occlusion.

The present study evaluated combined effects of chronic coronary occlusion and exercise training on endothelial function. Gradual occlusion was produced by placement of an ameroid constrictor around the proximal left circumflex (LCX) coronary artery of female swine. Two months after placement of the ameroid, animals were restricted to their pens or exercise trained for 16 wk. Epicardial arteries (>500 microm ID) were isolated from the collateral-dependent LCX coronary artery distal to the occlusion and the nonoccluded left anterior descending (LAD) coronary artery. Bradykinin- and ADP-mediated relaxation of LCX and LAD coronary arteries was enhanced after exercise training. Inhibition of nitric oxide synthase with N(G)-nitro-L-arginine methyl ester decreased bradykinin- and ADP-mediated relaxation in LCX and LAD myocardial regions. Importantly, combined inhibition of effects of endothelium-derived hyperpolarizing factor with increased extracellular K(+) (20-30 mM) and nitric oxide synthase completely abolished coronary LAD and LCX relaxation to bradykinin. Our data indicate that exercise training improves endothelium-mediated relaxation of arteries isolated after chronic coronary artery occlusion, likely as a result of enhanced production of nitric oxide and endothelium-derived hyperpolarizing factor.