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Roxane McKay, MD, FRCS, FRCSCa, Robert H. Anderson, BSc, MD, FRCPathb

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Presentation on theme: "Roxane McKay, MD, FRCS, FRCSCa, Robert H. Anderson, BSc, MD, FRCPathb"— Presentation transcript:

1 The coronary arteries in hearts with discordant atrioventricular connections 
Roxane McKay, MD, FRCS, FRCSCa, Robert H. Anderson, BSc, MD, FRCPathb*, Audrey Smith, PhD, FIBMSc  The Journal of Thoracic and Cardiovascular Surgery  Volume 111, Issue 5, Pages (May 1996) DOI: /S (96) Copyright © 1996 Mosby, Inc. Terms and Conditions

2 Fig. 1 Problems in describing sinusal origins of coronary arteries are encapsulated in these cartoons. Usual arrangement in normal heart (a). Observer positioned in nonfacing sinus of aorta, looking toward pulmonary trunk, has morphologically right coronary artery arising from right-hand sinus (No. 1 in Leiden convention) and morphologically left coronary artery from left-hand sinus (No. 2). In complete transposition, situation is complicated because with most common arrangement (b), when viewed from aorta, the morphologically right coronary artery arises from sinus (No. 2). This is now to observer's left hand. For complete transposition, concordance between handedness of sinuses and arterial origin can be restored by viewing facing sinuses from a stance in pulmonary trunk (c). To retain this harmonious arrangement when dealing with congenitally corrected transposition it is necessary for observer to take up a position once more in nonfacing aortic sinus (d). This arrangement also holds good for cases with sinusal and commissural mismatch. A, Anterior; L, left; P, posterior; R, right; r, right coronary artery; a, anterior interventricular artery; c, circumflex artery; CCTGA, congenitally corrected transposition; CT, complete transposition. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

3 Fig. 2 A, View from top of heart with congenitally corrected transposition after transection of aorta and pulmonary trunk. Commissure between coronary arterial sinuses is poorly aligned (arrows). There is trifurcation of morphologically left coronary artery immediately after its origin (asterisks), and morphologically right coronary artery gives off large infundibular branch (curved arrow). B, Dilemma for classifying sinuses is illustrated in cases in which interostial commissure is poorly aligned and further compounded in presence of single sinusal origin (see text). A,L,P,R, Anterior, left, posterior, right; L, left-hand facing sinus from pulmonary trunk; R, right-hand facing sinus from pulmonary trunk; S, sinus nodal artery; cctga, congenitally corrected transposition; a, anterior interventricular artery; c, circumflex artery; r, right coronary artery. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

4 Fig. 2 A, View from top of heart with congenitally corrected transposition after transection of aorta and pulmonary trunk. Commissure between coronary arterial sinuses is poorly aligned (arrows). There is trifurcation of morphologically left coronary artery immediately after its origin (asterisks), and morphologically right coronary artery gives off large infundibular branch (curved arrow). B, Dilemma for classifying sinuses is illustrated in cases in which interostial commissure is poorly aligned and further compounded in presence of single sinusal origin (see text). A,L,P,R, Anterior, left, posterior, right; L, left-hand facing sinus from pulmonary trunk; R, right-hand facing sinus from pulmonary trunk; S, sinus nodal artery; cctga, congenitally corrected transposition; a, anterior interventricular artery; c, circumflex artery; r, right coronary artery. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

5 Fig. 3 Origins and Branching Patterns of coronary arteries in discordant atrioventricular connections. Boxes 3.1 to 3.13 represent specimens with usual atrial arrangement. Box 3.14 represents specimen with mirror-imaged atrial arrangement. Numbers indicate distances between branching points in millimeters. Asterisk indicates direction of sinus nodal artery. Arrow indicates continuation as posterior interventricular artery. A, L, P, R, Anterior, left, posterior, right. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

6 Fig. 4 Viewed from nonfacing aortic sinus, morphologically right coronary artery arises above sinutubular junction in sinus 1 (straight arrow). Morphologically left coronary artery lies within sinus 2 (curved arrow). RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

7 Fig. 5 Early division of morphologically left coronary artery results in two secondary orifices within coronary arterial orifice (arrows). Note extension of aortic valvular leaflet onto right ventricular muscular trabeculation (see also Fig. 8). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

8 Fig. 6 A, Left ventricular coronary artery in 3-week old patient. B, Left ventricular coronary artery in 3-month old patient. In each specimen there are a large anterior interventricular branch, circumflex branch, and smaller branches to right ventricular free wall. Cx, Circumflex artery; LAD, left anterior descending (interventricular) artery; RV, right ventricular wall. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

9 Fig. 6 A, Left ventricular coronary artery in 3-week old patient. B, Left ventricular coronary artery in 3-month old patient. In each specimen there are a large anterior interventricular branch, circumflex branch, and smaller branches to right ventricular free wall. Cx, Circumflex artery; LAD, left anterior descending (interventricular) artery; RV, right ventricular wall. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

10 Fig. 7 A, Morphologically right coronary artery deeply imbedded in fat (asterisks). B, Proximal portion of morphologically right coronary artery imbedded in fat (asterisks) with intramyocardial branch (arrows). C, Internally, orifice of coronary artery illustrated in B has normal position within aortic sinus (arrow). Ao, Aorta. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

11 Fig. 7 A, Morphologically right coronary artery deeply imbedded in fat (asterisks). B, Proximal portion of morphologically right coronary artery imbedded in fat (asterisks) with intramyocardial branch (arrows). C, Internally, orifice of coronary artery illustrated in B has normal position within aortic sinus (arrow). Ao, Aorta. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

12 Fig. 7 A, Morphologically right coronary artery deeply imbedded in fat (asterisks). B, Proximal portion of morphologically right coronary artery imbedded in fat (asterisks) with intramyocardial branch (arrows). C, Internally, orifice of coronary artery illustrated in B has normal position within aortic sinus (arrow). Ao, Aorta. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

13 Fig. 8 Viewed from position of nonfacing sinus, aortic leaflet of sinus 2 extends downward within right ventricle (arrow), in contrast with normal attachments of leaflet tissue in other sinuses (asterisk indicates noncoronary sinus). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

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