Variations of coronary artery branching and topography

Abstract

Introduction. According to medical literature, the coronary arteries are subjected to some morphological peculiarities. The research findings on variations of the topography, size and branching of vessels are highly important. It should be taken into account in cardiology for diagnosing, preventing and selecting methods of treatment of cardiac diseases as well as in cardiac surgery in case of surgical interventions. Aim of the study. To identify the individual variations of topography and branching of the coronary arteries. Materials and methods. According to goal of our study, 9 isolated heart samples and 2 heartlung complex samples of adults and children were dissected by fine anatomic dissection method under binocular magnifier. The branching variations of the major coronary arteries and their topography were analyzed. The size of the arteries was measured and all the samples were photographed. The blood supply to the pericardial layer was examined on the basis of 13 samples of adults using the macromicroscopic method of elective Schiff staining of total anatomic preparations as described by M.G. Shubich and A.B. Khodos (1964, 1971), adjusted by the researchers of Human Anatomy Department (M. I. Ştefaneţ, 1991, 1998; I. Catereniuc, 2000; I. Catereniuc, M. Ştefaneţ, 2003). Results. The morphological peculiarities of the coronary arteries were examined using the macro-dissection method. The left coronary artery has demonstrated high-degree variability compared to the right coronary artery. The outer diameters of the coronary arteries were relatively constant. The diameter of the left coronary artery near the aorta varied in size between 3.5 mm and 6.5 mm. The vessel immediately divided into three branches. The diameter of the right coronary artery near the aorta varied in size between 4.0 mm and 9.0 mm. In all the examined samples, the artery had one branch with multiple small collateral ramifications along its length. In one sample, the right coronary artery split into two branches of equal diameter. The arteries and their branches disappeared in the depth of the cardiac muscle and pericardial layer. The advantage of the Schiff staining method is that the reagent dyes the thinnest vessels located relatively deep. This is extremely important for macro and microscopic examinations when it refers to the sources of blood supply. The stained preparations revealed vascular plexuses formed by branches of different coronary arteries and their intrasystemic overlapping areas, which serve as a defense mechanism. Conclusions. According to our findings, the diameter of coronary arteries varied. It depended on the heart size, on age and gender of the patient. The left coronary artery was wider in diameter and had a larger number of branches due to a considerably overload of the left heart chambers. Multiple anastomoses between the small branches of different arteries of the vascular plexuses and intrasystemic overlapping areas were revealed.