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Journal of the Anatomical Society of India

Anterior Interventricular Artery Replacing Left Coronary Artery With Absence Of Arterial Anastomosis In Human Heart

Author(s): Keshaw Kumar

Vol. 55, No. 1 (2006-01 - 2006-07)

Keshaw Kumar
Department of Anatomy M.L.N. Medical College Allahabad.

Abstract:

The hearts obtained from cadavers (288) were dissected in order to study anomalies in human coronary arteries. Only in one heart anterior interventricular artery replacing left coronary artery with absence of arterial anastomosis was found.

Key words: Coronary artery, Coronary sulcus, Circumflex branch, Heart.

Introduction:

Congenital anomalies of coronary arteries were discussed by Abbot (1927), Blake et al (1964) Hallman et al (1966) and Ogden (1970). The anomalous origin of left coronary artery from the pulmonary artery was observed by Askenazi and Nadas (1975), George and Knowlan (1959), Keith (1959) Wesselhoeft et al (1968) and Flamm et al (1968) while Ott et al (1978) found origin of circumflex artery from right pulmonary artery. Anomalous course and branches of human coronary arteries were described by Kumar (1989). A single coronary artery was noticed by Smith (1950) Sharbaugh and White (1974). Duplication of branches in human coronary arteries was reported by Kumar (1994). Yet the anterior interventricular artery replacing left coronary artery with absence of arterial anastomosis in human heart has not been described till date by any author The present study is conducted to observe replacement and anastomosis anomalies in human heart.

Material And Method:

The human hearts (288) procured from the dissection room cadavers were preserved in 10% formalin. Coronary arteries were dissected to find out the anomalies if any.

Observation

While dissecting the coronary arteries In 288 human hearts in one specimen it was found that arterial anastomosis was absent between interventricular arteries (Fig. 1 and 4) as well as marginal arteries (Fig. 2 and 3) because neither anterior and posterior Interventricular arteries reached the apical notch nor the right and left marginal arteries reached the apex of heart.

Right coronary artery (Fig. 1) commenced from anterior aortic sinus and running between the right atrium, and right ventricle In the coronary sulcus crossed the inferior border of heart (Fig. 3) to reach the diaphragmatic surface of heart. It travelled the entire length of coronary sulcus on the back of heart but it did not reach the left surface of heart.

Right marginal artery was tortuous. It commenced from right coronary artery at the inferior border of heart and running along inferior border of heart it sunk into the substance of heart about 3 cm medial to the apex of heart (Fig. 1 and 3).

Fig. 1: Anterior view of human heart

Fig. 1: Anterior view of human heart

Fig. 2: Left lateral view of human heart

Fig. 2: Left lateral view of human heart

Fig. 3: Right lateral view of human heart

Fig. 3: Right lateral view of human heart

Fig. 4: Posterior view of human heart

Fig. 4: Posterior view of human heart

After giving right marginal artery at the inferior border of heart right coronary artery divided into superior and inferior right circumflex arteries on the diaphragmatic surface of heart (Fig. 4) Superior right circumflex artery travelled the entire length of coronary sulcus on the back of heart and at the crux of heart it gave nodal artery and posterior interventricular artery

Discussion:

Anterior interventricular artery is broader replacing left coronary artery because it has to supply entire interventicular septum due to the fact that posterior interventricular artery is small and instead of running Into posterior interventricular sulcus it crosses the posterior interventricular sulcus running inferiorly and towards the left side. Thus posterior interventricular sulcus is almost devoid of any artery and entire interventricular septum is supplied by the anterior interventricular artery. Kumar (1994) also observed that in one human heart the middle 1/3 of anterior interventricular septum was supplied entirely by anterior interventricular artery.

Because posterior interventricular artery does not run into posterior interventricular sulcus to give branches to supply both the right and left ventricles on the diaphragmatic surface of heart and posterior interventricular artery runs on the diapheagmatic surface of left ventricle to sink into its substance, therefore, to supply diaphragmatic surface of right ventricle inferior right circumflex artery is present running inferior to right coronary artery. Kumar (1989) also found that in one human heart collateral branch of right coronary artery running inferior to coronary sulcus supplied right ventricle on diaphragmatic surface.

Deviation of left coronary artery taking an oblique course inferior to coronary sulcus resembles the deviation of left coronary artery noticed by Kumar (1989) in one human heart a feature observed in quadrupeds

Right coronary artery not only crosses the crux of heart but runs into the entire length of coronary sulcus on the back of heart therefore, it is a case of great dominance of right coronary artery described by Kumar ( 1989) in human heart.

Absence of anastomosis between the branches of coronary arteries indicates that in this case the coronary arteries are end arteries which is observed by the author for the first time in human heart. Division of right coronary artery into superior right circumflex and inferior right circumflex arteries resembles the findings of Kumar (1994) in one human heart.

In this case instead of running along the left border of heart left marginal artery first runs on the left surface of heart then it turns obtusely to run along the left border of heart. This type of description is not available in literature and it is observed by the author for the first time in human heart.

References

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  2. Askenazi, J. and Nadas, A.S. (1975). Anomalous left coronary artery originating from the pulmonary artery. Report on 15 cases. Circulation 51: 976.
  3. Blake, H.A.; Manion, W.C. ; Mat tingly, T.V’/. and Bardoli, G. (1964). Coronary artery anomalies. Circulation. 30: 927.
  4. George, J.M. and Knowlan, D.M. (1959). Anomalous origin of left coronary artery from the pulmonary artery in the adult. N. Engl. J. Med. 261: 933.
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  6. Hallman, G.L.; Cooley, D.A. and Singer, D.B. (1966). Congenital anomalies of the coronary arteries: Anatomy, Pahology and Surgical treatment. Surgery, 58: 133.
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  9. Keshaw Kumar (1990). Comparative anatomy of coronary arteries -A Gross study in mammals. Journal of Anatomical sciences. Vol. 12: 45 -51
  10. Keshaw Kumar (1994). Duplication of branches in human coronary arteries. Journal of Anatomical Sciences. 13: 9-12
  11. Ogden, J.A. (1970). Congenital anomalies of the coronary arteries. Am. J. Cardiol. 25: 474.
  12. Ott. D.A.; Cooley, D.A.; Pinskey, W.W.; Mullins, C.E. (1978). Anomalous origin of circumflex artery from right pulmonary artery. Report of a rare anomaly. J. thorac. Cardiovasc. Surg. 76: 190-194.
  13. Sharbaugh, A.H. and White, R.S. (1974). Single coronary artery. Analysis of anatomic variation. Clinical importance anc’ report of five cases. J.A.M.A. 230: 243.
  14. Wesselhoeft, H. Fawcett, J.S. and Johnson, A.L. (1968). Anomalous origin of left coronary artery from the pulmonary trunk. Its clinical spectrum. pathology and pathophysiology based on a review of 140 cases with seven further cases. Circulation, 38: 403.
  15. Smith, J.C. (1950). Review of single coronary with report of two cases. Circulation 7: 1168- 1175.
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