Anatomy Of The Coronary Arteries
Left coronary artery
It starts with an ostium placed at the half of the left coronary sinus, heading for the left coronary sulcus, situated between the pulmonary artery trunk and left ears. After this short route, it usually divides into two branches: the left anterior descending artery and the circumflex artery. Sometimes it can be divided into three branches, in this case the common trunk is originated and an intermediate ram.
Left anterior descending artery is considered the most important vessel of the heart, which irrigates most of the left ventricular myocardium. Descends in the anterior interventricular sulcus space with the large vein of the heart, it reaches the heart notch tip and can continue on the diaphragmatic face with recurrent artery, which rises 1-2 cm in the interventricular sulcus posterior. Anterior descending artery branches are:
– Previous septal branches that fall in palisade from anterior descending artery, 2/3 vascularization of the previous interventricular septum, the His bundle, right and left branches.
– From recurrent artery come off the posterior septal branches, that vascularizes the third posterior of the ventricular septum, at the top.
– Diagonal branches may vary in number and position. They irrigate the anterior wall of the left ventricle and part of the anterolateral papillary muscle.
– Previous right ventricular branches are few in number. There are usually left artery of the pulmonary cone (which together with a branch, the same in the right coronary artery which form “the ring of pulmonary arterial cone of Vieussens “).
Angiographic, anterior descending artery divides into three segments: the first from the ostium to the first diagonal (when it is lacking to the first septal), the second- between the first and second diagonal and third distal from the second diagonal.
The circumflex artery
It surrounds the heart through the left segment of the coronary sulcus, initially covered by the left lug, and then going with venous sinus in the left coronary sulcus. Ends variable, left or right compared to the crux cordis, usually after giving two or three branches to the lateral wall of the left ventricle-marginal artery and posterolateral branches, for the posterior wall. Not infrequently, descends in the posterior interventricular sulcus posterior as descending posterior artery from which septal branches that detach to the third of the ventricular septum. Irrigate the posterior and the lateral wall of the left ventricle and part of the anterolateral papillary muscle, also in 45% of cases, the sinus node artery. Inconstantly it can vascularize also the atrioventricular node.
Right coronary artery
Start in the middle region of the right coronary sinus through an ostium whose surface is placed mostly over the edge of the semilunar valve. The position of the ostium can be variable, as is the number of holes in sinus- two or three holes, representing the origin of an artery or arteries of the node sinoatrial. Right coronary artery engages in the middle of the right of the coronal sulcus, initially located between the right ear and pulmonary artery trunk, surrounds the hearts edge and reaches the right of the diaphragmatic. In case of dominant right, enters the posterior interventricular sulcus and become the artery posterior interventricular that will give septal branches for the posterior of the ventricular septum.
Angiography has three segments: proximal – from the ostium to the first knee artery, at the entrance in the coronary sulcus; medium – between the first and second knee artery, (corresponding to the path through the atrioventricular sulcus) and doistal (up to cordis crux- defined as right coronary artery bifurcation of the posterior interventricular artery and ram posterolateral). Right coronary artery branches are: the sinus node artery, the atrioventricular node artery, the pulmonary artery cone, which makes anastomoses with the left coronary artery and branches for the free wall of the right ventricular.