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Morphology of Coronary Arteries in Relation to Ischemic Heart Disease

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Morphology of Coronary Arteries in Relation to Ischemic Heart Disease Journal of Cardiology & Current Research Editorial Open Access Morphology of coronary arteries in relation to ischemic heart disease Abstract Volume 14 Issue 2 - 2021 Background: The anatomical features of the coronary circulation show some interesting Aurelio Leone1,2 data which have been obtained by both in vivo and post-mortem studies. 1Department of Internal Medicine, Fellow of the Royal Society Methods: This editorial describes the morphology and main alterations of coronary for Promotion of Health, UK 2 arteries, which supply blood flow to heart muscle, observed in the ischemic heart disease. Department of Internal Medicine, Fellow of the American Heart Association, USA Results: The great majority of myocardial muscle is under the control of the left coronary arteries: the left main coronary artery and its branches, the left anterior descending artery, Correspondence: Aurelio Leone, Department of Internal and circumflex artery, which provide several arterial vessels particularly to the left anterior Medicine, Fellow of the Royal Society for Promotion of Health, ventricular wall, interventricular septum and apex of the heart. Therefore, a large portion of UK, Email the posterior left ventricular wall is supplied by left coronary circulation. The right coronary Received: March 03, 2021 | Published: March 31, 2021 artery supplies blood flow to the posterior wall of the heart and the right atrium. Coronary anastomoses have been demonstrated into the myocardium showing that coronary arteries widely communicate among themselves. The main lesions of the coronary tree in subjects suffering from ischemic heart disease are related to coronary atherosclerosis. Conclusion: Morphology of coronary arteries is strongly influenced by ischemic pathology of the heart. Keywords: coronary circulation, coronary artery, morphology, ischemic heart disease, atherosclerosis, thrombosis Editorial Epicardial coronary arteries and intramyocardial circulation Ischaemic heart disease shows a strong epidemiological impact despite of the significant progresses obtained by diagnostic and The structure of epicardial and intramyocardial circulation of therapeutic approaches. This occurrence is a result of two main the coronary arteries explains possible different mechanisms of factors: the close relationship existing between epidemiology and cardiovascular damage observed in the individuals suffering from cardiovascular risk factors and, in addition, the type of alterations ischemic heart disease. Usually, the alterations are related to hypoxia affecting the coronary tree of the individuals suffering from ischemic that triggers anatomical and/or functional changes in vessel structures pathology, as many findings undoubtedly show.1-4 The analysis of the with a lumen reduction due to isolated or multiple stenoses of different anatomy of coronary tree is worthy of mention in an attempt to better size and degree. understand those alterations observed in the ischaemic heart disease. Physiologically, conduit vessels10 are cylindrical arteries that In-vivo angiography and post-mortem study of the coronary arteries reduce progressively their caliber along the entire length from their using a combined method of post-mortem injection plus dissection origin to the end. This geometrical characteristic allows carrying out provide those results which allow clarifying the morphology of the the basic function consisting of blood flow circulation. coronary tree.5–9 The purpose of this editorial, which summarizes a Geometrically, a cylinder is a uniform and hollow three- great number of personal findings previously published, is to discuss dimensional solid with straight sides and a circular section. It arises the morphological characteristics of the coronary arteries and the from a complete rotation of a side of a plane figure, a rectangle, relationship with ischemic heart disease. giving a three-dimensional solid. On the contrary, resistance Anatomical patterns of coronary arteries vessels are intramyocardial segments and their anastomoses, which play a basic role to regulate the coronary circulation. Indeed, heart Coronary arteries supply blood flow to the heart in both physiologic function by systolic and diastolic phases influences intramyocardial and pathologic conditions. The benchmark of the coronary circulation coronary vessels stronger than all other biochemical metabolites. By is providing the heart of an amount of blood volume depending on this mechanism, it contributes to regulate coronary blood flow and body needs, otherwise, adjusting the blood volume to metabolic intramyocardial metabolic changes. Major changes in resistance of demand of cardiac muscle when this parameter is changing with coronary circulation are mediated primarily by those intramyocardial regard to degree of cardiac working. coronary vessels having a diameter from 10mμ to 140mμ.10,11 Three major coronary vessels as conduit arteries (epicardial Anatomically, a specific type of gross and histologic structure vessels) together with an intricate network of end small arteries characterizes conduit and resistance coronary arteries as Table 1 characterize the coronary circulation. shows. Submit Manuscript | http://medcraveonline.com J Cardiol Curr Res. 2021;14(2):27‒32. 27 ©2021 Leone. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Copyright: Morphology of coronary arteries in relation to ischemic heart disease ©2021 Leone 28 Table 1 Morphological characteristics of coronary tree Coronary vessel Lumen diameter (mm) Myocardial distribution Epicardial arteries and first Conduit artery vessels 4.2+/-0.6 to 2.8+/-0.5 intramyocardial Intramyocardial coronary arteries, Resistance artery vessels 140 to 10mcr anastomoses intercoronary and intracoronary Arteriolar anastomoses, Capillary bed anastomoses) Epicardial coronary arteries anastomoses up to 40µm in diameter, differently filled, in most normal hearts exists. Two major coronary arteries, which arise from the sinus of Valsalva behind the aortic valve leaflets, and their branches, provide The left and right coronary arteries supply different myocardial blood flow to the heart. The two main coronary arteries are known areas, and the knowledge of blood flow distribution explains both as left main coronary artery and right coronary artery. Inconstantly, a the localization and course of myocardial alterations as well as the third coronary artery, named conus artery, originates from a separate relationship between the type and extent of the vascular lesion, which ostium in the right sinus in about 50 percent of individuals. Additional are associated to the ischemic heart disease. small ostia have been described to be into the right sinus, but with a The anterior descending artery goes vertically 1 to 1.5cm from poor role in regulating coronary blood flow. the left main coronary artery. It courses down into the anterior The left main coronary artery, starting from the left posterior sinus interventricular groove, reaches the anterior portion of the cardiac of Valsalva, goes between the pulmonary artery and the left auricular apex rounding the acute margin of the heart and, then, goes up the appendix. After a short course usually varying from 0.5cm. to 2cm. posterior interventricular groove for about 1cm. The left coronary It branches, usually, into two vessels, which are known respectively artery supplies (Table 2) particularly the anterior wall of the left as the anterior descending artery, the main coronary artery, and the ventricle, the bordering third of the anterior surface of the right circumflex artery. Left main coronary artery may branch in 60 percent ventricle, the anterior two-thirds of the interventricular septum and of cases12 in three or, very rarely, four small arteries. Among these, it most of the heart apex. Therefore, it extends the largest mass of the is worthwhile mentioning the diagonal artery because it supplies an left myocardium feeling maximally systolic and diastolic effects of important part of the marginal myocardium. The right coronary artery heart function. Along its course left anterior descending artery gives branches more distally about its origin compared to what characterizes off, in an usual order of origin, the first diagonal coronary artery, that left main coronary artery. Functionally, the coronary arteries were can arise, as it will be described, from the left main coronary artery, believed to be, in the past, end-arteries, although anatomically, the first septal perforator branch, and three to four septal perforator numerous intercoronary and intracoronary (or homocoronary) arteries as well as some other diagonal branches. Table 2 Myocardial areas supplied by the coronary arteries, both conduit and resistance vessels Coronary artery Caliper (mm) * Myocardial area supplied Anterior wall of the left ventricle Anterior descending coronary artery 4.5+/-0.5 Border third of the anterior surface of right ventricle Anterior and posterior right ventricular wall Right coronary artery 3.9+/-06 Posterior third of left ventricular wall Posterior third of interventricular septum Small portions of lateral wall of the left ventricle Circumflex coronary artery 3.7+/-0.4 Small portion of left ventricle anterior wall Small portion of left ventricle posterior wall Interventricular septum Diagonal artery Anterior wall of the left ventricle Anterior papillary muscle *Measures of the epicardial
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