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Chapter 4: Normal and Anomalous Coronary Arteries in Humans. Part 1

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Chapter 4: Normal and Anomalous Coronary Arteries in Humans. Part 1 Coronary Anery Anorulies: A Comprehensfue Approach, edited by P. Angelini. Lippincott Williams & Wilkins, Philadelphia O 1999 CHAPTER 4 Normal and Anomalous Coronary Arteries in Humans Paolo Angelini, Salvador Villason, Albert V. Chan,Jr., andJos6 G. Diez Part I The presence of a pulmonary circulation organized in se- ries with the systemic circulation had been postulated by HISTORICAL BACKGROUND isolated early researchers: Ibn-na-Nafis, a 13th-century Arab physician working in Damascus; Miguel Serveto, a passion- Interest in coronary anatomy and the nature of the coro- ate 16th-century Spanish theologian; and Cesalpino, a 16th- nary vessels was cautiously aroused in the 16th century, century anatomist from Padua, who coined the term "pulmo- when inquisitive Renaissance scholars began to perform ana- nary circulati on.' 'sz6 Nevertheless, it was not until 1628 that tomic investigations in the early European medical schools. William Harvey (1518-1651), a physician trained in Padua Until then, anatomic knowledge had been heavily influenced but later active in London, and Cambridge, propounded a by the philosophical and theological teachings ofthe ancient, clear, complete, organized concept ofthe circulation, thereby rediscovered masters of the Greek and Arabic schools. Aris- founding the discipline of physiologic anatomy. Discovery totle (384-322 BC), the philosophical interpreter of nature, of the systemic capillary network awaited the introduction and Galen of Pergamum (129-199 AD), the great physician, of the microscope. It was Marcello Malpighi (1628-1694), were the main authorities whose theories continued to domi- operating mainly in Bologna, who first described the circula- nate the medical schools of Salerno, Bologna, Padua, and tion of blood through the peripheral capillary network.s26 eventually Louvain, Paris, and London during the Renais- Regarding the coronary arteries in particular, the founder sance. of descriptive anatomy, the great Flemish anatomist Andreas Leonardo da Vinci (1452-1519), a lone, ingenious spirit, Vesalius (1514-1564), produced a series offundamental /c- examined a few animal hearts (probably of oxen) and also bulae anatomicae (Yenice, 1538), that were followed by his briefly touched on coronary anatomy while exploring the comprehensive treatise "De Humani Corporis Fabrica Libri arcane viscera of the chest.531 His main interest seemed to Septem" (Basel, 1543), which became the basic textbook be in applying the principles of hydraulic physics to cardio- of anatomy for generations of physicians throughout Europe. vascular function. Leonardo tended to rely on instinctive Interestingly, one famous tabula anatomica showed the right curiosity rather than organized, formal methods. He left us coronary artery GCA) originating from the left coronary only brief notes, accompanied by precise, faithful sketches artery (LCA) and coursing anterior to the pulmonary outflow of the coronary anatomy, including the aortic trifoliate valve, tract (Fig.4.2). Similarly, a single coronary ostium was men- the right and left coronary ostia, and the proximal course of tioned by Fallopius (Venice, 1562).so8 Not until 1761, did the right and left coronary arteries (Fig. a.l). He noted that G. P. Morgagni accurately and definitively describe the two the coronary arteries become progressively smaller as they main coronary vessels.so8 During the ensuing centuries, var* progress toward the cardiac apex.s3l He also accurately de- ious investigators published occasional descriptions of pe- scribed the coronary veins and the coronary sinus; his obser- culiar or unusual coronary anatomic features: the work of vation of the arrangement of these structures supported his A. C. Thebesius and R. Vieussens was especially note- assumption that an artery is always accompanied by a worthy.508 vein.s3l Leonardo's approach exemplified the new method With the advent of the 20th century, physicians became of critical, direct observation, which a little more than a increasingly aware of the complexity and variability of the century later would allow better-trained, more-disciplined coronary anatomy. 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Jourru, , suuel eql esn o1 pesodord ,(eql 'ecuecgru8rs leJrurlc uo peseq se,l qcuo;dde Jleql esn€ceg z;wrol pnldecuoc 'peleulpJooJ e uI selleluoue ,(reuoroc p1 -rueSuoc Surqucsep go lcelord Suueeuord eql >Ioouepun 'JC 6Z / sNvwng NI sf,nlsJr{V AuvNo)IoJ snorv7[oNl\y' oNV Tw{uofr{ 30 / Crreerrn 4 into two branches, one of which (transverse) continues on- ical solutions to be temporarily adopted by common agree- groove ward in the between the left auricle and ventricle. ment. The other (descending) courses along the posterior interven- tricular furrow. (Gray's Anatomy, 1901 editionsoe) METHODS FOR STUDYING CORONARY Since the beginning of this century, when the preceding MORPHOLOGY passage was published in a leading textbook of human anat- omy, there has been a continuously expanding awareness of Traditional descriptions of coronary morphology are the great variability of the coronary anatomy and the diffi- based on anatomic observations in necropsy specimens.
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