Main trunk of the left coronary artery: anatomic study of the parameters of clinical interest

The objective of this study was to analyze in one single series all the characteristics of the main trunk of the left coronary artery (MT) that may be of use in the diagnosis and treatment of its pathologies. One-hundred human hearts from autopsies were used. The average age of the sample studied was 63.15 years +/- 18.76 (range = 17-94 years). The heart was removed after resection of the costosternum and placed in 10% formaldehyde. With gradual separation and retraction of the myocardial fasciculi the MT was exposed. The length of the MT, the luminal diameter of the MT at its midpoint, and the luminal diameter of the left coronary orifice were measured with a caliper. The angle of division between the anterior interventricular and circumflex branches was also measured, and the number of terminal branches originating from the MT was recorded. In four cases, there was no MT and the anterior interventricular and circumflex branches originated directly from the left aortic sinus. The average length of the MT was 10.8 +/- 5.52 mm (range = 2-23 mm); the average diameter at its midpoint was 4.86 +/- 0.80 mm; and there was no significant difference noted between the midpoint diameter of the MT and the diameter of the left coronary orifice. The most frequent type of division of the MT was bifurcation (62%); in 38% of cases the MT divided into three or more branches. An average value of 86.7 +/- 28.8 degrees was obtained for the angle of division of the terminal branches of the MT (range = 40-165 degrees ). There was a positive correlation between the length of the MT and the angle of division of its terminal branches, with the longest MTs having the largest angle of division.     

Superdominant right coronary artery with absent left circumflex artery

Noninvasive imaging of coronary artery disease is rapidly replacing angiography as the first line of investigation. Multislice CT is the non-invasive modality of choice for imaging coronary artery disease and provides high speed with good spatial resolution. CT coronary angiography in addition to detecting and characterising atherosclerotic coronary artery disease is also a good imaging tool for evaluating anomalies of coronary arteries. Superdominant right coronary artery with absent left circumflex artery is one such rare coronary artery anomaly which is well evaluated with multislice CT angiography. The authors report one such case of superdominant right coronary artery with absent left circumflex artery imaged with 64-slice MDCT.     

右冠状动脉起源于左主干5例临床分析

目的：分析右冠状动脉起源于左主干的临床特征，探讨其与心肌缺血的关系。方法：回顾分析5例右冠状动脉起源于左主干的临床资料及相关文献。结果：（1）本组5例患者中，女性1例，男性4例，年龄27～70岁。（2）临床表现主要为胸痛、胸闷等心绞痛症状，除1例老年患者外，其余4例病人都有典型的心绞痛症状和缺血心电图变化。（3）冠状动脉造影示3例合并严重冠状动脉粥样硬化，给予冠状动脉搭桥术，术后随访2月～6年无明显不适；另2例冠状动脉无明显病变，药物治疗后仍有劳累性心绞痛发作，其中1例半年后猝死。结论：右冠状动脉起源于左主干是一种罕见的冠脉畸形，对存在严重心肌缺血的患者应进行预防性冠状动脉搭桥术或介入治疗，预防不良事件的发生。     

小儿左冠状动脉异常的矫治术麻醉管理方法探讨

目的分析小儿起源于肺动脉的左冠状动脉异常矫治手术的麻醉特点,为今后开展类似手术提供可行的麻醉管理方法。方法回顾性分析2006年3月至2010年7月本院20例小儿起源于肺动脉的左冠状动脉异常矫治术的麻醉管理方法。结果采用静吸复合全麻,术中均未出现急性心衰或心梗,CPB时间为58～204（80.6±44.4）min,主动脉阻断时间为25～125（53.4±32.2）min,开放主动脉后均自动复跳,适时应用血管活性药物,以保证麻醉平稳,停CPB时SBP为（78.6±8.0）mmHg,DBP为（45.4±3.5）mmHg,HR为（130.8±10.5）次/min,术中无死亡及麻醉并发症。1例术后第2天死于严重低心排综合征,死亡率为5%,其余痊愈出院。结论小儿左冠状动脉异常矫治术以静吸复合全麻的方法 ,辅以严密监测,尽力维持血流动力学稳定,积极采取各种措施避免加重心肌缺血的麻醉管理方法是正确可行的,可以推广应用于术前有心功能损害的手术。     

先天性左冠状动脉主干闭锁3例超声心动图特征及文献复习

目的 通过研究先天性左冠状动脉主干闭锁（LMCAA）的超声心动图表现,提高对LMCAA诊断的准确性.方法 回顾性分析经冠状动脉造影证实的3例LMCAA患儿的超声心动图检查结果,并复习相关文献,总结LMCAA超声心动图特征.结果 LMCAA特异性超声心动图特征：①主动脉左冠状动脉窦内无左冠状动脉主干开口,左冠状动脉主干近心端闭锁呈盲端,远心端内径细窄,发育不良;②右冠状动脉内径增宽;③多切面未显示左冠状动脉与肺动脉确切连接的证据.LMCAA非特异性超声心动图特征：①左心室明显扩大,左室收缩功能可正常或减低;②二尖瓣腱索、乳头肌回声显著增强,可伴有二尖瓣脱垂.彩色多普勒超声特征：①收缩期二尖瓣口可见中至大量反流信号;②左、右冠状动脉之间形成细小侧支循环; ③左冠状动脉前降支和回旋支血流为逆向灌注（向心性）;④发育不良的左冠状动脉虽然在肺动脉周围分布,但彩色多普勒超声不能显示其与肺动脉连接的确切逆灌血流信号.结论 LMCAA有特异性的超声心动图特征,提高对LMCAA的全面认识是诊断本病的关键.     

Extremely high origin of the right coronary artery from the ascending aorta.

Coronary artery anomalies, especially variations in the level of origin, are frequent. In most cases, the origin lies just a few millimeters superior to the supravalvular ridge; ectopic origins of more than one centimeter above this border are rare. We report a case in which the right coronary artery arises from the ascending aorta 38 mm above the supravalvular ridge.     

Concomitant multi-vessel disease is associated with a lower procedural death rate in patients treated with percutaneous coronary interventions within the left main coronary artery (from the ORPKI registry)

IntroductionIn this study, we aimed to distinguish differences in the procedural complication rate in a group of patients undergoing percutaneous coronary interventions (PCI) of the left main coronary artery (LMCA) between patients with isolated LMCA disease and multi-vessel disease (MVD) with LMCA involvement and to identify their predictors.Material and methodsWe assessed 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) regarding all PCI procedures performed in Poland in 2015 and 2016. We extracted data of 1,819 patients with isolated LMCA disease and 3,718 patients with MVD and LMCA involvement. We compared those two groups in terms of procedural complications and their predictors.ResultsThe overall rate of procedural complications was significantly higher in patients treated with LMCA PCI both in the group of patients with isolated LMCA (6.5%) and the group with MVD with LMCA involvement (7.3%) compared to the non-LMCA PCI group (1.9%, p = 0.002). Multivariate analysis confirmed that MVD with LMCA involvement is an independent predictor of decreased risk of procedural death in the overall group of patients undergoing PCI of the LMCA (odds ratio: 0.583; 95% confidence interval: 0.4–0.848; p = 0.005).ConclusionsThe MVD involvement in patients treated with PCI of the LMCA may play a protective role. Patients with isolated LMCA involvement undergoing PCI should be subjected to special care and protected by various methods, such as devices to support left ventricle function.     

The relationship of myocardial bridges to coronary artery dominance in the adult human heart

Myocardial bridging is recognized as an anatomical variation of the human coronary circulation in which an epicardial artery lies in the myocardium for part of its course. Thus, the vessel is 'bridged' by myocardium. The anterior interventricular branch of the left coronary artery has been reported as the most common site of myocardial bridges but other locations have been reported. The purpose of this study was to provide more definitive information on the vessels with myocardial bridges, the length and depth of the bridged segment, and the relationship between the presence of bridges and coronary dominance. Two hundred formalin-fixed human hearts were examined. Myocardial bridges were found in 69 (34.5%) of the hearts with a total of 81 bridges. One bridge was found in 59 of these hearts and multiple bridges were observed in ten (eight with double bridges and two with triple bridges). Bridges were most often found over the anterior interventricular artery (35 hearts). Bridges were also found over the diagonal branch of the left coronary artery (14), over the left marginal branch (five) and over the inferior interventricular branch of the left coronary artery (six). Bridges were also found over the right coronary artery (15 hearts), over the right marginal branch (four) and over the inferior interventricular branch of the right coronary artery (two). The presence of bridges appeared to be related to coronary dominance, especially in the left coronary circulation. Forty-six (66.6%) of the hearts with bridges were left dominant. Forty-two of these had bridges over the left coronary circulation and four over the right coronary circulation. Seventeen hearts (24.6%) were right dominant. Eleven of these had bridges over the right coronary circulation and six over the left coronary circulation. The remaining six hearts were co-dominant with four having bridges over the left coronary circulation and two over the right coronary circulation. The mean length of the bridges was 31 mm and the mean depth was 12 mm. The possible clinical implications of myocardial bridging may vary from protection against atherosclerosis to systolic vessel compression and resultant myocardial ischaemia.     

Impact of diabetes on mortality and complications after coronary artery by-pass graft operation in patients with left main coronary artery disease

PurposeLeft main disease (LMD) is a severe form of coronary artery disease (CAD). Fifty percent of patients with LMD treated conservatively die within 3–5 years of diagnosis. The aim of the study was to assess the influence of type 2 diabetes on early and late (2-year) prognosis and the risk of complications after coronary artery by-pass graft (CABG) surgery in patients with LMD.Material/methodsWe enrolled 257 patients diagnosed with LMD. 169 (67%) underwent CABG, 19 (8%) percutaneous coronary intervention (PCI) without left main stem protection. 30 (12%) patients had CABG previously. Patients treated with CABG were divided into two groups – with and without diabetes. There were 43 (25.4%) patients with diabetes and 126 (74.6%) without diabetes.ResultsWe observed more complications with wound healing (40.5% vs. 12.8%, p < 0.001) and sternal dehiscence (23.8% vs. 4.0%, p < 0.001) after CABG in patients with diabetes. There were no differences in 7-day, 30-day, 3-month and 1-year mortality. 2-Year mortality was also similar in both groups (11.6% vs. 11.1%, p = 0.928). Patients with diabetes were more frequently hospitalized due to other reasons than angina (39.5% vs. 20.6%, p = 0.014).ConclusionsPatients with diabetes and LMD had more often complications with wound healing and sternal dehiscence after CABG than patients without diabetes. Type 2 diabetes did not influence early and late mortality in patients with LMD treated with cardiac surgery, but the presence of diabetes was associated with more frequent hospitalizations.     

Ectopic "high" origin of both coronary arteries from the left aortic wall: anatomic and postmortem angiographic findings

Anatomic and postmortem angiographic findings of a previously unreported case of ectopic origins and unusual courses of the right coronary (RC) artery and the left coronary (LC) artery were demonstrated. This specimen was unique among 450 angiographies and 60 corrosion castings of the human hearts examined in this study. The ostium of the RC artery was pocket-like, located in the left aortic wall at roughly 180 degrees to the long axis of the ascending aorta and 19 mm above the rim of the sinotubular junction (SJ). Initially, the RC runs to the right and downward, passing high in the cleft between the aorta and the pulmonary trunk, thereby avoiding a possible compression from them. The ostium of the LC faced upward and originated from the left aortic wall 7 mm above the SJ. The LC ran to the left and downwards for 16 mm until its division. Histologically, the first 11 mm of the RC were elastic. This observation, together with its high course between the great vessels, combined to make this case benign. The best x-ray projections to show the characteristic findings of the present case were anteroposterior and lateral, which were of practical importance for the correct determination and interpretation of this case. The cardiac surgeon should be aware that high cannulation will be required to locate the RC to avoid accidentally cross-clamping or transecting the vessel during surgery where this anomaly may be encountered.     

Ectopic "high" origin of both coronary arteries from the left aortic wall: anatomic and postmortem angiographic findings

Anatomic and postmortem angiographic findings of a previously unreported case of ectopic origins and unusual courses of the right coronary (RC) artery and the left coronary (LC) artery were demonstrated. This specimen was unique among 450 angiographies and 60 corrosion castings of the human hearts examined in this study. The ostium of the RC artery was pocket-like, located in the left aortic wall at roughly 180 degrees to the long axis of the ascending aorta and 19 mm above the rim of the sinotubular junction (SJ). Initially, the RC runs to the right and downward, passing high in the cleft between the aorta and the pulmonary trunk, thereby avoiding a possible compression from them. The ostium of the LC faced upward and originated from the left aortic wall 7 mm above the SJ. The LC ran to the left and downwards for 16 mm until its division. Histologically, the first 11 mm of the RC were elastic. This observation, together with its high course between the great vessels, combined to make this case benign. The best x-ray projections to show the characteristic findings of the present case were anteroposterior and lateral, which were of practical importance for the correct determination and interpretation of this case. The cardiac surgeon should be aware that high cannulation will be required to locate the RC to avoid accidentally cross-clamping or transecting the vessel during surgery where this anomaly may be encountered.     

胃网膜动脉与冠状动脉搭桥术的应用解剖

为胃网膜动脉与冠状动脉搭桥术提供解剖学资料。本文在30具成年尸体上对胃网膜动脉、网膜动脉和冠状动脉进行了观测。测量结果:胃网膜动脉弓长度为29.3cm;而胃网膜右动脉的起始部至主动脉根部为28.9cm;胃网膜左动脉起始部至主动脉根部为29.2cm。测量数据表明,应用胃网膜动脉移位术足以吻接任何冠状动脉。     

小儿左冠状动脉异常起源于肺动脉的外科矫治

目的 总结小儿左冠状动脉异常起源于肺动脉（ALCAPA）的外科矫治方法及效果。方法 回顾性研究。纳入2015年2月—2020年10月泰达国际心血管病医院9例接受外科手术治疗的小儿ALCAPA患者的临床资料。男2例、女7例,年龄0.2~12.3岁（中位年龄1.7岁）,体质量5.7~44.3 kg（中位体质量11.6 kg）。患者采取个体化手术策略（肺动脉内隧道技术、主动脉壁和带蒂肺动脉壁缝合、带蒂直接移载、左主干开口成形术）恢复双源冠状动脉供血,其中4例同期行二尖瓣成形术。观察指标：监测患儿左心室射血分数（LVEF）和二尖瓣反流程度,并比较其在术前、术后早期、末次随访时的变化。结果 全组患儿均手术顺利,无死亡。2例重症婴儿术后延迟关胸6 d和9 d。9例患儿出院后获随访1个月~4.5年,均未出现心绞痛或心力衰竭症状。患儿术后早期与术前LVEF分别为62.1%（39.0%,63.5%）和59.0%（40.0%,64.5%）,差异无统计学意义（Z=14.00,P=1.000）;末次随访LVEF为64.0%（60.5%,67.5%）,较术后早期改善,差异有统计学意义（Z=26.50,P=0.034）。术后早期二尖瓣反流与术前、末次随访比较,差异均无统计学意义（Z=1.13、1.41,P=0.257、0.157）。结论 对于小儿ALCAPA采用个性化外科矫治手术可以获得满意的近中期效果。     

Variant origin of the ulnar artery

Axillary origin of the ulnar artery was observed during an angiographic examination of the upper extremity. The ulnar artery originated from the axillary artery at the level of the anterior and posterior circumflex humeral arteries. No additional anomalies were observed. Accurate knowledge about unusual patterns of the arteries of the upper extremities is important in order to be aware of hidden hazards during diagnostic and therapeutic preparations. Clin. Anat. 11:62–64, 1998. © 1998 Wiley-Liss, Inc.     

Demonstration of an anomalous connection between the left coronary artery and the pulmonary artery using a multislice CT 64

In this article, we describe two cases of anomalous connection of the left coronary artery. The first case is an infant of 4 years with an anomalous origin of the left anterior descending (LAD) artery and the diagonal branches and a circumflex artery which originated from the pulmonary artery. The second case is an adult of 50 years with the coronary artery originating from the pulmonary artery. Anomalous origin of the left coronary artery from the pulmonary artery is an uncommon congenital cardiac anomaly with an incidence of 0.25% among all congenital heart defects (Parale and Pawar [2006], J Assoc Physicians India 54:397-399). The originality of this communication consists in the use of a multislice CT scanner as a support for the angiography. The result is an original image with three dimensional details; in the case of the infant, it was determinant in the choice of the surgical approach.     

Rare coronary anastomoses between the aorta,pulmonary trunk,left coronary artery,and subclavian artery

We report a rare case of coronary anastomoses in an 83‐year‐old male cadaveric heart. Anomalous vessels arose from the right sinus of the aorta, left main coronary artery, left anterior descending artery, left anterior medial atrial artery, and left subclavian artery. These vessels bifurcated and anastomosed, and finally connected to the pulmonary trunk. The present case is categorized as a multilateral coronary artery fistula in cardiology. Clin. Anat. 25:969–972, 2012. © 2012 Wiley Periodicals, Inc.     

Anatomic variant of the posterior interventricular coronary artery: Implications for coronary angioplasty in acute myocardial infarction

Acute thrombotic occlusion of an infarct-related artery is frequently found in patients presenting with myocardial infarction. In a patient with acute inferior wall myocardial infarction complicated by continuous chest pain and hemodynamic instability, emergency diagnostic coronary arteriography demonstrated a patent, infarct-related, “pseudo” right coronary artery while, in fact, this vessel was a rare anatomic variant of the posterior interventricular branch with very early origin from the right coronary artery and the true right coronary artery was completely occluded by a thrombotic obstruction. Accurate anatomic-angiographic interpretation of the angiogram was crucial for successful performance of emergency recanalization and revascularization of the true right coronary artery with laser and balloon angioplasty. Once antegrade flow was restored another rare coronary variant was discovered, i.e., a sinoatrial node artery arising from the middle portion of the newly patent right coronary artery. Clin. Anat. 10:303–306, 1997. © 1997 Wiley-Liss, Inc.     

Risk factor reduction in progression of angiographic coronary artery disease

Introduction

To investigate differences between outpatients with progressive and nonprogressive coronary artery disease (CAD) measured by coronary angiography.

Material and methods

Chart reviews were performed in patients in an outpatient cardiology practice having ≥ 2 coronary angiographies ≥ 1 year apart. Progressive CAD was defined as 1) new non-obstructive or obstructive CAD in a previously disease-free vessel; or 2) new obstruction in a previously non-obstructive vessel. Coronary risk factors, comorbidities, cardiovascular events, medication use, serum low-density lipoprotein cholesterol (LDL-C), and blood pressure were used for analysis.

Results

The study included 183 patients, mean age 71 years. Mean follow-up duration was 11 years. Mean follow-up between coronary angiographies was 58 months. Of 183 patients, 108 (59%) had progressive CAD, and 75 (41%) had nonprogressive CAD. The use of statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aspirin was not significantly different in patient with progressive CAD or nonprogressive CAD Mean arterial pressure was higher in patients with progressive CAD than in patients with nonprogressive CAD (97±13 mm Hg vs. 92±12 mm Hg) (p<0.05). Serum LDL-C was insignificantly higher in patients with progressive CAD (94±40 mg/dl) than in patients with nonprogressive CAD (81±34 mg/dl) (p=0.09).

Conclusions

Our data suggest that in addition to using appropriate medical therapy, control of blood pressure and serum LDL-C level may reduce progression of CAD.