A Cadaveric Study Of Coronary Dominance And Prevalence Of Myocardial Bridges In South Indian Population

Background: Cardiovascular disease is one of the leading causes of morbidity and mortality in the world. Theaim of this study is to observe the branching pattern of left coronary artery with special attention to the originand termination of the posterior interventricular artery(PIVA), to determine the coronary dominance and theoccurrence of myocardial bridges over the anterior interventricular artery(AIVA). Myocardial bridging is acongenital anomalous condition in which a coronary artery takes a “tunneled” course under a “bridge” ofoverlying myocardium. The vessel is compressed in systole, resulting in angina, myocardial ischemia, acutecoronary syndrome, left ventricular dysfunction, sudden cardiac death and arrhythmias.Materials and Methods: This study was taken up at the Institute of Anatomy, Madurai Medical College with 60heart specimens collected from the cadavers of the same Institute and from the Department of Forensic Medicine.The heart specimens of different age groups, sex and socioeconomic status were preserved in 10% formalin andstudied by the conventional dissection method.Results: Among the 60 heart specimens studied, left coronary artery was seen bifurcating in 62%, trifurcating in32% and quadfurcating in 6%. Regarding dominance, right dominance with PIVA arising from right coronaryartery was seen in 53 specimens (88.3%), left dominance with PIVA being the continuation of left circumflexartery(LCX) was seen in 5 specimens(8.3%) and PIVA was arising from both coronaries in 2 specimens(3.4%).Among the 5 left dominant specimens, PIVA was seen as a continuation of LCX artery in 4 and single whereas in1 specimen the PIVA was seen to be double. With regard to termination of PIVA, it terminated in the middle ofposterior interventricular sulcus(PIVS) in 2 specimens and at the junction of anterior 1/3 and posterior 2/3 ofPIVS in the rest. Myocardial bridges were seen over anterior interventricular artery in 15 specimens (25%).Conclusion: Right dominance is seen in majority of hearts followed by left dominance and the balanced patternbeing the least. Presence of myocardial bridges was predominantly seen over AIVA.

A Study Of Coronary Dominance In Population Of North Karnataka

Introduction: With the increase in the trend of modern sedentary lifestyle, the coronary heart diseases have alsoincreased. The need to understand coronary artery anatomy in detail has become ever so important because ofwide variations in the anatomy and various anomalies noted in different populations. Knowledge of coronarydominance is important to understand the severity of coronary artery diseases and plan the treatment ofcardiovascular diseases. It determines the amount of myocardium that is perfused by the left or right coronarycirculation.Materials and Methods: 100 adult formalin fixed heart specimens were collected from routine under graduateand post graduate dissection at Belgaum Institute of Medical Sciences, Belagavi irrespective of sex and age. Theorigin of posterior interventricular artery was examined and dissected. Results were noted and compared withprevious studies.Results: Out of 100 specimens studied in 83 (83 %) specimens the posterior interventricular artery was arisingfrom right coronary artery and in other 17 (17%) specimens it arose from Left circumflex artery. In none of thespecimens studied the posterior interventricular artery was arising from both the coronary arteries.Conclusion: The knowledge of normal anatomy and variations of coronary dominance will help interventionalcardiologist, cardio-thoracic surgeons and radiologist of North Karnataka region in proper management ofpatients.

Coronary irrigation in Puma concolor (Carnivora: Felidae) / Irrigación coronaria en Puma concolor (Carnivora: Felidae)

This study described the anatomy of the coronary arteries and their main branches in Puma concolor. The hearts of six individuals of Puma concolor, were analyzed. The A. coronaria sinistra formed the ramus interventricularis paraconalis and the ramus circunflexus. A ramus septal was formed close to the origin of the ramus interventricularis paraconalis and yielded from six to eight ventricular branches. The circumflex branch originated from two to five atrial branches and from three to seven ventricular branches. The right coronary artery formed two to six atrial branches, and four to nine ventricular branches. In half of the individuals, an accessory coronary artery was identified as the first branch of the right coronary artery. In all individuals, the subsinusal interventricular branch originated in the right coronary artery. It could be inferred that coronary circulation in Puma concolor is balanced, as each coronary artery yielded an interventricular branch and there was no significant difference in the total number of branches that originated from each coronary artery. These findings are different from the descriptions of most carnivore species, and may aid a better understanding of the phylogenetic relationships and synapomorphies of carnivore coronary circulation, especially in the Felidae family.

En este estudio se describió la anatomía de las arterias coronarias, y sus principales ramas, en el Puma concolor. Se analizaron los corazones de seis especímenes de Puma concolor. La arteria coronaria izquierda formó la rama interventricular paraconal y la rama circunfleja. Una rama septal se formó cerca del origen de la rama paraconal y otorgó de seis a ocho ramas ventriculares. La rama circunfleja originó de dos a cinco ramas atriales y de tres a siete ramas ventriculares. La arteria coronaria derecha originó de dos a seis ramas atriales y de cuatro a nueve ramas ventriculares. En la mitad de los especímenes, se identificó una arteria coronaria accesoria como la primera rama de la arteria coronaria derecha. En todos los individuos, la rama interventricular subsinusal se originó en la arteria coronaria derecha. Se podría inferir que la circulación coronaria en el Puma concolor es equilibrada, ya que cada arteria coronaria produce una rama interventricular y no hay diferencia significativa en el número total de ramas que se originan de cada arteria coronaria. Estos hallazgos son diferentes de las descripciones de la mayoría de las especies carnívoras y pueden ayudar a una mejor comprensión de las relaciones filogenéticas y de las sinapomorfias de la circulación de los carnívoros, especialmente en la familia Felidae.

A Cadaveric Study on Coronary Preponderance.

Background: Knowledge of coronary preponderance is important to understand coronary artery diseases, interpret the findings and plan the treatment of cardiovascular diseases. It influences the amount and anatomic location of myocardium that is perfused by the left or right coronary circulation. The aim of the present study is to observe the origin of posterior interventricular artery which determines the coronary preponderance or dominance. Materials and Methods: The study was done on 50 formalin fixed adult heart specimens in the Department of Anatomy, Bangalore Medical College and Research Institute irrespective of age, sex, socio-economic status, religion and education status. The coronary arteries were examined by gross dissection and analyzed statistically. Results: Right preponderance was seen in 31(62%) hearts, left preponderance in 11 (22%) hearts and balanced or codominance was seen in 8(16%) hearts. Discussion: The coronary artery dominance has an important clinical significance.Most of the studies have reported a higher percentage of right preponderance including the present study. Results of the present study was compared statistically with the study done by Hirak Das et al (n=70). On comparison right dominance was statistically insignificant ( z = 0.91, p = 0.36 ), left dominance was statistically insignificant ( z = 0.46 , p = 0.64), and balanced pattern was also statistically insignificant ( z = 0.82 , p = 0.41 ) Conclusion: The present study on coronary dominance would be of use to the cardiologist and interventional radiologist to predefine the abnormalities by invasive and non invasive studies.

Evaluation of coronary dominance in pigs; a comparative study with findings in human hearts / Avaliação da dominância coronária em suínos. Estudo comparativo com os achados em corações humanos

Coronary dominance in swine has been poorly evaluated. The frequencies of each type of dominance have been described, but few details have been given as to the different expressions of each one. The aim of this study was to characterize coronary dominance in commercial breed swine. One hundred and fifty eight pig hearts were evaluated. The coronary arteries (CA) were infused with synthetic resin (Palatal 85% and Styrene15%) through the ostia after channeling. The coronary artery that gives origin to the posterior interventricular artery (PIA), and the site of termination of both the circumflex arteries (CXA), and left retroventricular branch (LRVB) were determined in order to establish the coronary dominance pattern. Right coronary dominance was found in 105 hearts (66.5%), and a balanced circulation in 53 specimens (33.5%). No dominance was observed for the left coronary artery in the hearts studied. The CXA ended on the posterior aspect of the left ventricle in 101 samples (64%) and on the crux cordis in 55 specimens (34.8%). In two specimens (1.3%) it ended as a left marginal artery. In all cases the PIA was a branch of the RCA, and was long in 105 hearts (66%), 55% of which corresponded to males and 45% to females, but this difference was not statistically significant (p=0.77). The AIA ended on the apex in 126 specimens (80%), 71 of which (56%) corresponded to males and 55 (44%) to females (p=0.74)...

A dominância coronária em suínos tem sido pouco avaliada. Descreveram-se as frequências de cada um dos tipos, mas não detalharam as diferentes expressões de cada um deles. O objetivo deste estudo foi caracterizar a dominância coronária em suínos de raças comerciais. Avaliaram-se 158 corações de suínos. As artérias coronárias (AC) foram infundidas através da canalização dos seus ostium com resina sintética (Palatal 85% e Estireno15%). Para estabelecer o tipo de dominância coronária, determinou-se de qual coronária desprendia-se a artéria interventricular posterior (AIP) e o lugar de finalização das artérias circunflexa (ACX) e do ramo retro ventricular esquerdo (RRVI). Encontrou-se dominância coronária direita em 105 corações (66%) e circulação balanceada em 53 exemplares (34%). Não foi observada a dominância coronária esquerda nos corações estudados. O calibre proximal e médio da ACD nos casos de dominância coronária direita foi de 3,84 ± 0,80 mm. Por outro lado, encontrou-se que este mesmo calibre nos corações com dominância coronária balanceada foi de 3,97 + 0,79 mm. (p=0,88). A ACX finalizou-se na face posterior do ventrículo esquerdo em 101 amostras (64%) e na crux cordis em 55 exemplares (34,8%). A AIP emergiu em todos os casos da ACD sendo comprida em 105 corações (66%) dos quais 55% correspondia a machos e 45% a fêmeas, sem que esta diferença fosse estatisticamente significativa (p=0,77). A AIA finalizou-se no ápice em 126 exemplares (80%), dos quais 71 (56%) corresponderam a machos e 55 (44%) a fêmeas (p=0,74)...

A Study of Coronary Dominance in Population of Jalgaon Region of North Maharashtra by Angiographic Method.

Introduction: The incidence of coronary artery disease is increasing now a day’s all over the world. Dominance pattern of the heart has got important clinical significance in different pathologies. So the present work is undertaken to study the dominance of coronary arteries in population of Jalgaon region of North Maharashtra, India. Aim and objectives: Aim of the present study was to determine dominance pattern of coronary arteries in Jalgaon region and to compare it with other studies. Material and Method: The subjects (n=1000) attending cardiology outpatient department (OPD) at Dr. Ulhas Patil Medical College and Hospital, Jalgaon Kh. formed the study group for this study. Invasive coronary angiography was performed by either femoral or radial route using radio-opaque dye and cineangiograms were taken in different views. Using Schlesinger’s criteria, the coronary dominance was determined Results: In 82.4% of the subjects, right dominance was noted. In 13.3% of the subjects, left dominance was noted. Balanced dominance was noted in 4.3% of the subjects studied. Conclusion: Balanced dominance is significantly less in Jalgaon region of northern Maharashtra when compared with results of most other studies. Similarly right dominance is significantly more in this area when compared with results of most other studies. So it can be concluded that every region carries its own proportions of dominance and detailed studies should be conducted for betterment of human being in each region.

Percentage Incidence, Morphology and Morphometry of Myocardial Bridges: A Cadaveric Study.

Introduction: Myocardial bridging is the term used when a segment of major epicardial coronary artery runs intramuscularly under the tunnel formed by fibers of myocardium that bridges instead of it’s normal or routine epicardial path. In the literature there are varying reports on clinical implications of myocardial bridges from protection against atherosclerosis to myocardial ischemia, as well as leading to infarction and sudden cardiac death. Materials and Methods: 150 adult formalin fixed human hearts which were available in the department of Anatomy and Forensic Medicine, S.V.Medical College, Tirupati, Andhra Pradesh, India. These hearts were dissected and observed for the presence, location, type, number and direction of myocardial bridges and their association with coronary dominance. With the help of digital calipers morphometric parameters (length, width& thickness) of myocardial bridges and length of blood vessel underneath the myocardial bridge were measured, noted and photographs were taken. Results: The overall incidence of myocardial bridges was 20.6%( 31/150). Among these 18.6% (28/31) were on left anterior descending (LAD) artery and 2% (03/31) were on posterior interventricular (PIV) artery. The direction of muscle fibers in the bridges were oblique to the direction of the coronary vessels in majority of cases. Length, width and thickness of myocardial bridges were in the range of 12-69.7mm, 3.74-8.6mm and 1.3-3.87mm respectively. Conclusions: Myocardial bridges may be associated with wide range of clinical problems. Contraction of myocardial bridge may results in vascular compression and myocardial ischemia. Knowledge on morphology and morphometric details of myocardial bridges facilitates cardiologists in diagnosis, planning therapeutic strategies and prognostic predictions.

Anatomic parameters of the left coronary artery: an angiographic study in a south african population / Parámetros anatómicos de la arteria coronaria izquierda: estudio angiográfico en una población sudafricana

An understanding of the left coronary artery (LCA) anatomy is important for accurate diagnosis and therapeutic intervention in the management of coronary arterial diseases. This angiographic study aims to document the parameters of the LCA that may be of importance in the diagnosis and treatment of coronary artery diseases. An analysis of 151 coronary angiograms obtained from the cardiac catheterization laboratory in the eThekwini Municipality area of KwaZulu-Natal, South Africa was performed. The mean length and diameter of the LCA were 10.4+/-4.1 mm (range 2.8-23.9 mm) and 3.8+/-0.8 mm (range 2.1-6.5 mm), respectively. The mean angle of division between the two main branches was 86.2°+/-26.1° (range 27°-68.5°). There was a positive correlation between the length and the angle of division of the LCA, with the longest LCAs having the largest angle of division. The branching patterns of the LCA were 80.8 percent, 18.5 percent and 0.7 percent for bifurcation, trifurcation and quadrifurcation, respectively. Coronary arterial dominance was 81.5 percent, 15.2 percent, and 3.3 percent for right, left, and co-dominance, respectively. This study corroborated earlier findings that the longer the length, the wider the angle of LCA division. A wide angle of LCA division, the shape and disposition of the proximal tract of LCA branches may affect flow, interfere with proper deployment of stents or may predispose to earlier atherosclerotic lesions.

La comprensión anatómica de la arteria coronaria izquierda (ACI) es importante para el diagnóstico e intervención terapéutica en el tratamiento de enfermedades arteriales coronarias. Este estudio angiográfico tuvo como objetivo documentar los parámetros de la ACI que pueden ser de importancia en el diagnóstico y tratamiento de enfermedades de las arterias coronarias. Se realizó el análisis de 151 angiografías coronarias obtenidas del laboratorio de cateterización cardíaca en el área del Municipio eThekwini de KwaZulu-Natal, Sudáfrica. La longitud y diámetro promedio de la ACI fueron 10,4+/-4,1 mm (rango 2,8 a 23,9 mm) y 3,8+/-0,8 mm (rango de 2,1 hasta 6,5 mm), respectivamente. El ángulo medio de la división entre las dos ramas principales fue 86,2°+/-26,1° (rango 27°­168,5°). Hubo una correlación positiva entre la longitud y el ángulo de división de la ACI, donde las ACI más largas tuvieron un ángulo de división más grande. Los patrones de ramificación de la ACI fueron porcentualmente 80,8 por ciento, 18,5 por ciento y 0,7 por ciento para bifurcación, trifurcación y quadrifurcación, respectivamente. La dominancia arterial coronaria fue del 81,5 por ciento, 15,2 por ciento y 3,3 por ciento para la derecha, izquierda y en co-dominio, respectivamente. Este estudio corrobora hallazgos anteriores en que cuanto mayor sea la longitud, mayor será el ángulo de la división de ACI. Un amplio ángulo de la división de la ACI, la forma y la disposición del tracto proximal de las ramas de la ACI pueden afectar el flujo, interferir con el despliegue apropiado de los stents o predisponer a las lesiones ateroscleróticas tempranas.

Estudo anatômico das artérias coronárias em caprinos / Anatomic study of coronary arteries in goats

A utilização de artérias coronárias de caprinos em pesquisas experimentais com objetivos de futuras aplicações em coronárias humanas motivou o interesse em verificar semelhanças ou diferenças morfológicas das artérias coronárias de caprinos com os citados na literatura para humanos. Foram utilizados 31 corações de caprinos SRD pesando de 76,5-107,7g fixados em formalina a 10 por cento. As artérias coronárias e seus ramos eram dissecados até as ramificações visíveis sob o pericárdio. A artéria coronária esquerda presente em todos os corações era única. Seu comprimento situou-se entre 8 mm e 17mm, terminava formando os ramos: interventricular paraconal e circunflexo (90,3 por cento) ou interventricular paraconal, circunflexo e angular (9,7 por cento). O ramo interventricular paraconal, presente em todos os corações era único. Seu comprimento variou de 80 a 140mm, emitia média de 12 ramos. O ventrículo direito recebia 49,5 por cento dos ramos e o ventrículo esquerdo, 50,5 por cento, dos ramos. Essa artéria podia terminar antes de atingir o ápice do coração (22,5 por cento), no próprio ápice (22,5 por cento) ou então passava pelo ápice e terminava no sulco interventricular subsinuoso (55 por cento). O ramo circunflexo era único, comprimento variou de 61 a 106mm, emitia média de 8,2 ramos. O ventrículo esquerdo recebia 53,4 por cento dos ramos e o átrio esquerdo, 46,6 por cento. Em todos os casos essa artéria chegava e ultrapassava a Crux cordis. A artéria coronária direita, presente em todos os corações, era única. Seu comprimento variou de 35 a 86mm, emitia a média de 8,6 ramos. O ventrículo direito recebia 56,1 por cento, dos ramos e o átrio direito 43,9 por cento. Em geral era a própria artéria que se comportava como ramo marginal direito. A artéria coronária direita não atingia a Crux cordis em 93,5 por cento. O ramo interventricular subsinuoso da artéria circunflexa podia ser: a) ramo longo ocupando a maior parte do sulco; b) ramo curto ...

The coronary arteries of the goats have been used to researches about to pharmacological actions, heart failure after connection of coronary arteries and others. Twenty-seven goat hearts, both sexes, fixed in formalin at 10 percent has been used in this study that analyzed the coronary arteries pattern in goats and if the same is similar to the human coronary arteries pattern. The left coronary artery is dominant and in relation to the length demonstrated average 1.15cm emitting two branches: interventricular paraconalis and circumflex. The interventricular paraconalis branch with average length 10.5cm issued branches to the both ventricles fairly, ending more frequently in the interventricular subsinuosis sulcus. The circumflex branch with average length 8.5cm issued branches to left ventricle and right atrium fairly. The left marginal branch is not constant. The right coronary artery, with average length 6.1cm issued branches to right ventricle and right atrium fairly, but the interventricular subsinuosis branch with average length 3.1cm is variable and can present one long branch, one short branch or one double branch, with the huge part for the right ventricle.