Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T19:41:01.541Z Has data issue: false hasContentIssue false
  • English
  • Français

Understanding coronary arterial anatomy in the congenitally malformed heart*

Published online by Cambridge University Press:  18 January 2013

Robert H. Anderson ,
Ing-Sh Chiu ,
Diane E. Spicer  and
Anthony J. Hlavacek
Robert H. Anderson*
Affiliation:
Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Ing-Sh Chiu
Affiliation:
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Diane E. Spicer
Affiliation:
Division of Pediatric Cardiology, University of Florida, Gainesville, United States of America Congenital Heart Institute of Florida, Saint Petersburg, Florida, United States of America
Anthony J. Hlavacek
Affiliation:
Division of Cardiology, Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, United States of America
*
Correspondence to: Professor R. H. Anderson, BSc, MD, FRCPath, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel.: +44 20 8870 4368; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

With the development of three-dimensional techniques for imaging, such as computed tomography and magnetic resonance imaging, it is now possible to demonstrate the precise sinusal origin and epicardial course of the coronary arteries with just as much accuracy as can be achieved by the morphologist holding the heart in his or her hands. At present, however, there is no universally accepted convention for categorising the various patterns found when the heart is congenitally malformed. In this review, we show how, to provide such a convention, it is necessary to take note not only of the sinusal origin of the three major coronary arteries, but also the relationship of the aortic root relative to the cardiac base. We summarise the evidence showing how the proximal portions of the developing coronary arteries grow into the aortic valvar sinuses subsequent to the separation of the aortic root from the subpulmonary infundibulum. We also discuss the evidence showing that the subpulmonary myocardium is impervious to the passage of epicardial coronary arteries, and suggest that the process of septation itself plays an integral role in guiding the arteries into the two aortic sinuses that are adjacent to the pulmonary root. We then show how marriage of convenience between the epicardial coronary arteries and the aortic valvar sinuses provides a good explanation for the known variations found in the setting of transposition. We point out that it is the absence of septation that likely governs the patterns seen in the setting of a common arterial trunk.

Keywords

Anterior interventricular arteryright coronary arterycircumflex coronary arterytranspositioncommon arterial trunk
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 6: A Lifelong Interdisciplinary Approach to Common Arterial Trunk, Transposition of the Great Arteries, and Other Evolving Challenges in Paediatric and Congenital Cardiac Disease , December 2012 , pp. 647 - 654
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at the 12th Annual International Symposium on Congenital Heart Disease, February 17–21, 2012, All Children's Hospital, Saint Petersburg, Florida, United States of America.

References

1. Shaher, RM, Puddu, GC. Coronary arterial anatomy in complete transposition of the great vessels. Am J Cardiol 1966; 17: 355–361.CrossRefGoogle ScholarPubMed
2. Yacoub, MH, Radley-Smith, R. Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. Thorax 1978; 33: 418–424.CrossRefGoogle ScholarPubMed
3. Gittenberger-de Groot, AC, Sauer, U, Oppenheimer-Dekker, A, Quaegebeur, J. Coronary arterial anatomy in transposition of the great arteries: a morphologic study. Pediatr Cardiol 1983; 4 (Suppl I): 15–24.Google Scholar
4. Chiu, IS, Chu, SH, Wang, JK, et al. Evolution of coronary artery pattern according to short-axis aortopulmonary rotation: a new categorization for complete transposition of the great arteries. J Am Coll Cardiol 1995; 26: 250–258.CrossRefGoogle ScholarPubMed
5. Chiu, IS, Wu, SJ, Chen, SJ, et al. Sequential diagnosis of coronary arterial anatomy in congenitally corrected transposition of the great arteries. Ann Thorac Surg 2003; 75: 422–429.CrossRefGoogle ScholarPubMed
6. Huang, SC, Chiu, IS, Lee, ML, et al. Coronary artery anatomy in anatomically corrected malposition of the great arteries and their surgical implications. Eur J Cardiothorac Surg 2011; 39: 705–710.CrossRefGoogle ScholarPubMed
7. Hackensellner, HA. Akzessorische kranzegefassanlagen der arteria pulmonalis unter 63 menschlichen embryonenseries mit einer grossten lange von 12 bis 36 mm. Zeitsch f Mikro Forsh 1956; 62: 153–164.Google Scholar
8. Bogers, AJ, Gittenberger-de Groot, AC, Poelmann, RE, Peault, BM, Huysmans, HA. Development of the origin of the coronary arteries, a matter of ingrowth or outgrowth? Anat Embryol 1989; 180: 437–441.CrossRefGoogle ScholarPubMed
9. Hutchins, GM, Kessler-Hanna, A, Moore, GW. Development of the coronary arteries in the embryonic human heart. Circulation 1988; 77: 1250–1257.CrossRefGoogle ScholarPubMed
10. Crupi, G, Macartney, FJ, Anderson, RH. Persistent truncus arteriosus. A study of 66 autopsy cases with special reference to definition and morphogenesis. Am J Cardiol 1977; 40: 569–578.CrossRefGoogle ScholarPubMed
11. Suzuki, A, Ho, SY, Anderson, RH, Deanfield, JE. Coronary arterial and sinusal anatomy in hearts with a common arterial trunk. Ann Thorac Surg 1989; 48: 792–797.CrossRefGoogle ScholarPubMed
12. Bogers, AJ, Bartelings, MM, Bokenkamp, R, et al. Common arterial trunk, uncommon coronary arterial anatomy. J Thorac Cardiovasc Surg 1993; 106: 1133–1137.CrossRefGoogle ScholarPubMed
13. Angelini, P. Coronary artery anomalies. An entity in search of an identity. Circulation 2007; 115: 1296–1305.CrossRefGoogle ScholarPubMed
14. Kurosawa, H, Imai, Y, Kawada, M. Coronary arterial anatomy in regard to the arterial switch procedure. Cardiol Young 1991; 1: 54–62.CrossRefGoogle Scholar
15. Hlavacek, A, Loukas, M, Spicer, D, Anderson, RH. Anomalous origin and course of the coronary arteries. Cardiol Young 2010; 20 (Suppl 3): 20–25.CrossRefGoogle ScholarPubMed
16. Virágh, S, Challice, CE. The origin of the epicardium and the embryonic myocardial circulation in the mouse. Anat Rec 1981; 201: 157–168.CrossRefGoogle ScholarPubMed
17. Pérez-Pomares, JM, Phelps, A, Sedmerova, M, et al. Experimental studies on the spatiotemporal expression of WT1 and RALDH2 in the embryonic avian heart: a model for the regulation of myocardial and valvuloseptal development by epicardially derived cells (EPDCs). Dev Biol 2002; 247: 307–326.CrossRefGoogle Scholar
18. Angelini, P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J 1989; 117: 418–434.CrossRefGoogle ScholarPubMed
19. Theveniau-Ruissy, M, Dandonneau, M, Mesbah, K, et al. The de122q11.2 candidate gene Tbx1 controls regional outflow tract identity and coronary artery patterning. Circ Res 2008; 103: 142–148.CrossRefGoogle ScholarPubMed
20. Lacour-Gayet, F, Anderson, RH. A uniform surgical technique for transfer of both simple and complex patterns of the coronary arteries during the arterial switch procedure. Cardiol Young 2005; 15 (Suppl 1): 93–101.CrossRefGoogle ScholarPubMed
21. Jaggers, JJ, Cameron, DE, Herlong, R, Ungerleider, RM. Congenital heart surgery nomenclature and database project: transposition of the great arteries. Ann Thorac Surg 2000; 69 (4 Suppl): S205–S235.CrossRefGoogle ScholarPubMed
22. Chiu, IS, Anderson, RH. Can we better understand the known variations in coronary arterial anatomy? Ann Thorac Surg 2012; 94: in press.CrossRefGoogle ScholarPubMed
23. Wernovsky, G, Sanders, SP. Coronary artery anatomy and transposition of the great arteries. Coron Artery Dis 1993; 4: 148–157.CrossRefGoogle ScholarPubMed
24. Landolt, CC, Anderson, JE, Zorn-Chelton, S, Guyton, RA, Hatcher, CR Jr, Williams, WH. Importance of coronary artery anomalies in operations for congenital heart disease. Ann Thorac Surg 1986; 41: 351–355.CrossRefGoogle ScholarPubMed
25. Collett, RW, Edwards, JE. Persistent truncus arteriosus: a classification according to anatomic types. Surg Clin North Am 1949; 29: 1245–1270.CrossRefGoogle ScholarPubMed
26. Van Praagh, R, Van Praagh, S. The anatomy of common aorticopulmonary trunk (truncus arteriosus communis) and its embryologic implications. A study of 57 necropsy cases. Am J Cardiol 1965; 16: 406–425.CrossRefGoogle ScholarPubMed
27. Chiu, IS, Wu, SJ, Chen, MR, Chen, SJ, Wang, JK. Anatomic relationship of the coronary orifice and truncal valve in truncus arteriosus and their surgical implication. J Thorac Cardiovasc Surg 2002; 123: 350–352.CrossRefGoogle ScholarPubMed
28. Van Mierop, LHS, Patterson, DF, Schnarr, WR. Pathogenesis of persistent truncus arteriosus in light of observations made in a dog embryo with the anomaly. Am J Cardiol 1978; 41: 755–762.CrossRefGoogle Scholar
29. Anderson, RH, Chaudhry, B, Mohun, TJ, et al. Normal and abnormal development of the intrapericardial arterial trunks in humans and mice. Cardiovasc Res 2012; 95: 108–115.CrossRefGoogle ScholarPubMed
30. Chiu, IS, Wu, CS, Wang, JK, et al. Influence of aortopulmonary rotation on the anomalous coronary artery pattern in tetralogy of Fallot. Am J Cardiol 2000; 85: 780–784.CrossRefGoogle ScholarPubMed
31. Chiu, IS, Wu, MH, Chang, CI, et al. Clinical implications of short-axis aortopulmonary rotation on juxtacommissural origin of the coronary artery in transposition of the great arteries and surgical strategy. J Card Surg 1997; 12: 23–31.CrossRefGoogle ScholarPubMed
32. Chiu, IS, Wang, JK, Wu, MH, et al. Angiographic evidence of long-axis rotation in addition to short-axis aortopulmonary rotation: its implication in transposition of the great arteries. Cathet Cardiovasc Diagn 1996; 39: 21–30.3.0.CO;2-4>CrossRefGoogle ScholarPubMed