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Predominant location of coronary artery atherosclerosis in the left anterior descending artery. The impact of septal perforators and the myocardial bridging effect. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:379-85. [PMID: 26855661 PMCID: PMC4735546 DOI: 10.5114/kitp.2015.56795] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/07/2015] [Indexed: 12/17/2022]
Abstract
Introduction Coronary artery atherosclerosis presents characteristic patterns of plaque distribution despite systemic exposure to risk factors. We hypothesized that local hemodynamic forces induced by the systolic compression of intramuscular septal perforators could be involved in atherosclerotic processes in the left anterior descending artery (LAD) adjacent to the septal perforators’ origin. Therefore we studied the spatial distribution of atherosclerosis in coronary arteries, especially in relation to the septal perforators’ origin. Material and methods 64-slice computed tomography angiography was performed in 309 consecutive patients (92 male and 217 female) with a mean age of 59.9 years. Spatial plaque distribution in the LAD was analyzed in relation to the septal perforators’ origin. Additionally, plaque distribution throughout the coronary artery tree is discussed. Results The coronary calcium score (CCS) was positive in 164 patients (53.1%). In subjects with a CCS > 0, calcifications were more frequent in the LAD (n = 150, 91.5%) compared with the right coronary artery (RCA) (n = 94, 57.3%), circumflex branch (CX) (n = 76, 46.3%) or the left main stem (n = 42, 25.6%) (p < 0.001). Total CCS was higher in the LAD at 46.1 (IQR: 104.2) and RCA at 34.1 (IQR: 90.7) than in the CX at 16.8 (IQR: 61.3) (p = 0.007). In patients with calcifications restricted to a single vessel (n = 54), the most frequently affected artery was the LAD (n = 42, 77.8%). In patients with lesions limited to the LAD, the plaque was located mostly (n = 37, 88.1%) adjacent to the septal perforators’ origin. Conclusions We demonstrated that coronary calcifications are most frequently located in the LAD in proximity to the septal branch origin. A possible explanation for this phenomenon could be the dynamic compression of the tunneled septal branches, which may result in disturbed blood flow in the adjacent LAD segment (milking effect).
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Dhobale MR, Puranik MG, Mudiraj NR, Joshi UU. Study of Third Coronary Artery in Adult Human Cadaveric Hearts. J Clin Diagn Res 2015; 9:AC01-4. [PMID: 26557505 DOI: 10.7860/jcdr/2015/14735.6676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/07/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Third coronary artery (TCA) is a direct branch arising from the anterior aortic sinus (right aortic sinus) which supplies right ventricular outflow tract. It is found frequently and may be an important source for collateral coronary blood flow through a vascular anastomotic bridge (circle of Vieussens) between the right and left coronary systems. AIM To evaluate the gross anatomy of third coronary artery in terms of their number, origin, extent and distribution. MATERIALS AND METHODS After an ethical approval, 150 formalin fixed adult human cadaveric hearts were collected from Department of Anatomy, BVDU Medical College and Hospital, Sangli and Pune over the period of six years. The careful dissection was carried out to note details about third coronary artery and data was analysed using SPSS computer software. RESULTS The TCA was present in 32% of the heart specimens. In 42 hearts (28%) single TCA and in 6 hearts (4%) double TCA were noted. It was found to be variably distributed to conus arteriosus, anterior wall of the right ventricle, interventricular septum and the apex of the heart. TCA was larger than right coronary artery in 8 hearts and later ended at inferior border of heart. Myocardial bridge was noted over large third coronary artery in one specimen. CONCLUSION TCA is present frequently. It anastomoses with branches of left anterior descending artery (LADA) and contributes to apical and septal perfusion. Hence role of TCA should always be considered during diagnostic and therapeutic interventions.
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Affiliation(s)
- Manisha Randhir Dhobale
- Assistant Professor, Department of Anatomy, Bharati Vidyapeeth Deemed University Medical College and Hospital , Sangli, Maharashtra, India
| | - Medha Girish Puranik
- Professor, Department of Anatomy, Bharati Vidyapeeth Deemed University Medical College and Hospital , Pune, India
| | - Nitin Radhakishan Mudiraj
- Professor and Head, Department of Anatomy, Bharati Vidyapeeth Deemed University Medical College and Hospital , Sangli, Maharashtra, India
| | - Uttama Umesh Joshi
- Associate Professor, Department of Anatomy, Bharati Vidyapeeth Deemed University Medical College and Hospital , Sangli, Maharashtra, India
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Wasilewski J, Roleder M, Niedziela J, Nowakowski A, Osadnik T, Głowacki J, Mirota K, Poloński L. The role of septal perforators and "myocardial bridging effect" in atherosclerotic plaque distribution in the coronary artery disease. Pol J Radiol 2015; 80:195-201. [PMID: 25922625 PMCID: PMC4404747 DOI: 10.12659/pjr.893227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 12/19/2014] [Indexed: 11/09/2022] Open
Abstract
The distribution of atherosclerotic plaque burden in the human coronary arteries is not uniform. Plaques are located mostly in the left anterior descending artery (LAD), then in the right coronary artery (RCA), circumflex branch (LCx) and the left main coronary artery (LM) in a decreasing order of frequency. In the LAD and LCx, plaques tend to cluster within the proximal segment, while in the RCA their distribution is more uniform. Several factors have been involved in this phenomenon, particularly flow patterns in the left and right coronary artery. Nevertheless, it does not explain the difference in lesion frequency between the LAD and the LCx as these are both parts of the left coronary artery. Branching points are considered to be the risk points of atherosclerosis. In the LCx, the number of side branches is lower than in the LAD or RCA and there are no septal perforators with intramuscular courses like in the proximal third of the LAD and the posterior descending artery (PDA). We hypothesized that septal branches generate disturbed flow in the LAD and PDA in a similar fashion to the myocardial bridge (myocardial bridging effect). This coronary architecture determines the non-uniform plaque distribution in coronary arteries and LAD predisposition to plaque formation.
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Affiliation(s)
- Jarosław Wasilewski
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Marcin Roleder
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jacek Niedziela
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Andrzej Nowakowski
- Department of Mechanical Engineering, University of Sheffield, Sheffield, U.K
| | - Tadeusz Osadnik
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jan Głowacki
- Department of Diagnostic Imaging, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Kryspin Mirota
- Department of Mechanical Engineering Fundamentals, Faculty of Mechanical Engineering and Computer Science, University of Bielsko-Biała, Bielsko-Biała, Poland
| | - Lech Poloński
- 3 Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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Terminal branching pattern of the right coronary artery in left-dominant hearts: a cadaveric study. Cardiovasc Pathol 2013; 22:179-82. [DOI: 10.1016/j.carpath.2012.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 08/09/2012] [Accepted: 08/11/2012] [Indexed: 11/20/2022] Open
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Burton RAB, Schneider JE, Bishop MJ, Hales PW, Bollensdorff C, Robson MD, Wong KCK, Morris J, Quinn TA, Kohl P. Microscopic magnetic resonance imaging reveals high prevalence of third coronary artery in human and rabbit heart. Europace 2013; 14 Suppl 5:v73-v81. [PMID: 23104918 DOI: 10.1093/europace/eus276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The human coronary tree is commonly assumed to have two roots: the left and right coronary arteries (LCA and RCA, respectively). However, a third coronary artery (TCA) has been observed in humans and animals, usually arising from the right anterior aortic sinus near the RCA. Using high-resolution magnetic resonance imaging, we identified TCA prevalence and characteristics in rabbit and human hearts. METHODS AND RESULTS Third coronary artery presence was analysed in hearts from 11 New Zealand white rabbits and 7 human cadavers, using excised tissue that was fixed, gadolinium-treated, and agar-embedded for imaging-based reconstruction. A TCA was identified in all rabbit hearts and six of seven human hearts, originating either from an independent ostium (7 of 11 rabbits, 2 of 7 humans) or an ostium shared with the RCA (4 of 11 rabbits, 4 of 7 humans). Proximal TCA cross-sectional area in rabbits was 15.3 ± 6.0% of RCA area (mean ± SD, based on n = 9 rabbit hearts in which reliable measurements could be taken for both vessels), and 26.7 ± 10.1% in humans (n = 4). In all-but-one case where a TCA was observed, it originated ventral to the RCA, progressing towards the right ventricular outflow tract. In one rabbit, the TCA originated dorsal to the RCA and progressed towards the Crista terminalis in the right atrium. A fourth vessel, forming a separate aortic Vas vasorum was occasionally seen, originating from the right anterior aortic sinus either from an ostium common with (1 of 11 rabbits, 0 of 7 humans) or independent of (1 of 11 rabbits, 1 of 7 humans) the TCA. Pilot optical mapping experiments showed that TCA occlusion had variable acute effects on rabbit cardiac electrophysiology. CONCLUSION Third coronary artery presence is common in rabbit and human hearts. Functional effects of disrupted TCA blood supply are ill-investigated, and the rabbit may be a suitable species for such research.
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Affiliation(s)
- Rebecca A B Burton
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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Takeguchi T, Ibukuro K, Fukuda H, Tobe K, Abe S. Anatomy of right superior septal artery demonstrated on the coronary CT scan. Acta Radiol 2012; 53:23-7. [PMID: 22184679 DOI: 10.1258/ar.2011.110277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A coronary CT scan allows for non-invasive visualization of the anatomy of a coronary artery in three dimensions compared to the two dimensions afforded by conventional angiography. The septal artery, the main blood source of the interventricular septum, is usually derived from the left anterior descending artery; however, it is occasionally derived from the right coronary artery. PURPOSE To analyze the prevalence, origin, diameter, and length of the right superior septal artery (RSSA) demonstrated on a coronary CT scan. MATERIAL AND METHODS The right superior septal artery was retrospectively reviewed on the reconstructed axial scan images (0.5-mm thickness, 0.25-mm interval) in 1290 consecutive patients who underwent coronary CT scans. All patients were scanned on a 320-row CT scanner. The images were transferred to a workstation to trace the vessel to analyze the origin, diameter, and length. We also compared the length of the RSSA between patients with and without coronary artery stenosis. RESULTS The RSSA was identified in 51 (3.9%) of 1290 patients. The origin was the proximal portion of the right coronary artery (n = 40) or the right sinus of Valsalva (n = 11). The artery co-existed with the conus artery in 15 (29%) of 51 patients. The length was 16-62 mm (mean 31.2 mm ± 10.5), and the diameter was 0.8-2.0 mm (mean 1.3 mm ± 0.2). Longer RSSAs tended to be demonstrated in the patients with coronary artery stenosis rather than with normal coronary arteries (P < 0.05). CONCLUSION The right superior septal artery and its anatomical variant could be analyzed with a coronary CT scan. The ability to demonstrate this artery on the coronary CT scan was the same as with coronary angiography. The recognition of this vessel is useful for physicians managing with the diagnosis and treatment of the coronary artery disease.
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Affiliation(s)
- Takaya Takeguchi
- Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo
- Tokyo Medical and Dental University, Department of Diagnostic Radiology, Tokyo, Japan
| | - Kenji Ibukuro
- Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo
| | - Hozumi Fukuda
- Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo
| | - Kimiko Tobe
- Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo
| | - Shoko Abe
- Mitsui Memorial Hospital, Department of Diagnostic Radiology, Tokyo
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Saremi F, Vorobiof G. Aberrant penetrating posterior descending artery from proximal right coronary artery. Clin Anat 2011; 24:956-8. [DOI: 10.1002/ca.21250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 06/21/2011] [Accepted: 07/15/2011] [Indexed: 11/10/2022]
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Partridge JB, Ridley LJ. The cristal (right superior septal) coronary artery and its relationship to anomalous left coronary origin. Clin Radiol 2011; 66:993-7. [PMID: 21663898 DOI: 10.1016/j.crad.2011.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 03/23/2011] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
Abstract
The cristal artery is an occasional finding, being visible in around 3% of coronary angiograms, arising from the proximal right coronary artery (RCA) and passing downwards and forwards through the muscle of the crista superventricularis. It supplies a variable volume of the superior interventricular septum, and can contribute to collateralization of the other septal vessels. When part or all of the left coronary artery (LCA) arises anomalously from the right coronary sinus, its passage to the left may be in the same pathway as a cristal artery, bearing a tell-tale septal vessel arising from its proximal segment. This helps to differentiate it from one that has a higher pathway, running between the great vessels, and which may have a greater correlation with sudden cardiac death.
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Saremi F, Abolhoda A, Ashikyan O, Milliken JC, Narula J, Gurudevan SV, Kaushal K, Raney A. Arterial Supply to Sinuatrial and Atrioventricular Nodes: Imaging with Multidetector CT. Radiology 2008; 246:99-107; discussion 108-9. [DOI: 10.1148/radiol.2461070030] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Durán AC, Fernández MC, Fernández B, Fernández-Gallego T, Arqué JM, Sans-Coma V. Number of Coronary Ostia in Syrian Hamsters (Mesocricetus auratus) with Normal and Anomalous Coronary Arteries. Anat Histol Embryol 2007; 36:460-5. [DOI: 10.1111/j.1439-0264.2007.00788.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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