354 Venugopal GE. et al. / International Journal of Biological & Pharmaceutical Research. 2016; 7(11): 354-359. e- ISSN 0976 - 3651 Print ISSN 2229 - 7480 International Journal of Biological & Pharmaceutical Research Journal homepage: www.ijbpr.com IJBPR A STUDY OF BRANCHING PATTERN OF CORONARY ARTERIES IN HUMAN CADAVERS G.E. Venugopal*, V. Muniappan, K. Vengadachalam Department of Anatomy, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India. ABSTRACT Coronary artery disease is the commonest cause of heart diseases and the most important cause of death all over the world. Coronary artery occlusion may either result in myocardial infarction or lead onto ischemia and angina pectoris. The recent advances in direct coronary artery surgery, the newly invented techniques in bypass surgery and the modern methods of revascularisation require a complete knowledge of the coronary circulation. The study of coronary arteries regarding its course and distribution was conducted at the Department of anatomy-RMMC, Annamalai University. 50 heart specimen age group of 20 – 65 years were studied. After cadaveric dissection, 50 heart specimens were collected from dissection hall for a period of 3 years.Manual dissection was done in 50 adult heart specimens, from dissection hall.Detailed description of material collection.It arises from the anterior aortic sinus, the artery passes at first anteriorly and slightly to the right between the right auricle and pulmonary trunk where the sinus usually bulges. Reaching the atrioventricular (coronary) sulcus it descends in this almost vertically to the right (acute) cardiac border, curving around it into the posterior part of the sulcus , where it approaches its junction with both interatrial and interventricular grooves, a region appropriately termed the crux of the heart.LCA arises from the left posterior aortic sinus .In its course, it lies between the pulmonary trunk and the left auricle emerging to reach the atrioventricular sulcus, in which if turns to the left. In this situation, it may give rise occasionally to the „artery of the Sinoatrial node‟ (James 1961) the LCA – reaches the atrioventricular (or) coronary sulcus & divides into 3 main branches of which the anterior interventricular (descending) ramus is commonly described as the continuation of LCA.As the study of the various patterns of coronary arteries with variations, is essential for the clinicians, the coronary arterial pattern was studied in 50 heart specimens. According to the description of our Bible, Gray‟s Anatomy (39th edition), the study was carried out and compared with our present observations. Key Words: Coronary artery, Anatomy. INTRODUCTION The introduction of selective coronary arteries and their variations is therefore absolutely arteriography (Sones, 1959) provides accurate visualization necessary for interpretation of angiography, ECG-gated of the artery and its pathology. The recent development of multi-director row CT findings and intelligent plan of electrocardiographically (ECG)-gated multi-detector row coronary surgery. computed tomography (Cardiac CT) allows accurate and The heart is supplied by the right and left noninvasive depiction of coronary artery pathology. A coronary arteries which encircle the base of the ventricles sound knowledge of normal anatomy of the coronary like a crown. Variation with relation to origin, course and termination are most frequently reported in the right Corresponding Author coronary artery. According to angiographic study in western population done (Topez et al., 1992), the right G.E. Venugopal coronary artery was the most common anomalous artery. Email: [email protected] 355 Venugopal GE. et al. / International Journal of Biological & Pharmaceutical Research. 2016; 7(11): 354-359. It has been proved that the anomalous coronary arteries are anatomy (Grossman, 2000). The performance of high associated with high incidence of congenital heart diseases. quality coronary arteriography safely defining each and Angiographic recognition of anomalous coronary every coronary stenosis in an optimal view is an important arteries prior to cardiac surgery is important. Failure to measure of an operator‟s skill in cardiac catheterization recognise them can cause inadequate or prolonged which emphasizes the importance of complete knowledge procedures and may lead to misdiagnosis and of coronary artery anatomy. complications such as accidental ligation (Donaldson, 1982). An inadvertent incision of the anomalous artery or MATERIALS & METHODS failure to perfuse the anomalous vessel during Method of Removal of heart specimen from cadavers cardiopulmonary bypass (Longenecker et al.,1961) may The thorax as the shape of a truncated cone, result in acute myocardial infarction (Mahowald et superiorly continuous with neck and inferiorly with al.,1986). Obstruction of the ostium (Lillehei et al., 1964) abdomen. The vital organ heart is situated in the thoracic of an anomalous artery and compression along its course cavity. A transverse incision was made through the by a valvular prosthesis also have been reported (Roberts, manubrium sternum to expose underneath parts. Another 1969). incision was made through the parietal pleura in the first The stress on need for detailed study of the intercostal space extending from the lateral sternal border coronary arteries is further emphasized by the fact that a up to the left mid-axillary line. From the ends of the line high incidence of the coronary anomalies has been the second and subsequent ribs were divided inferiorly up observed in young victims of sudden death as compared to to the level of xiphisternal joint. The lower part of the adults (4-15 percent versus 1 percent respectively) (Engel sternum and the costal cartilage and anterior parts of the HJ et al., 1975) With increasing utilization of coronary ribs were elevated. The parietal pleura extending from arteriography in the diagnosis of ischemic heart disease back of sternum up to the mediastinum on both sides were and with the advent of ECG-gated multi-detector row CT, divided. unexpected origin and course of coronary arteries are The upper part of the sternum was lifted up by encountered more frequently. This study of origin and dividing the sternopericardial ligaments. variation of right coronary artery is done with an The fibrous pericardium was separated from the expectation that it will hopefully contribute to better and adjoining structure by dividing the fibrous pericardium. complete interpretation angiographic studies, prevent The heart was exposed and delivered out of middle unwanted surgeries due to misdiagnosis and better mediastinum by cutting branches of Arch of Aorta, utilisation of anomalous vessels in bypass Surgeries. superior and inferior vena cava, pulmonary artery and The branching structure of vascular system has veins. been the subject of much discussion and debate since it After the removal of heart specimen from the was first suggested that these systems have fracial cadavers they were preserved in 10% formalin solution for architecture (Mandelbrott, 1977). Coronary artery of 1 week. The heart after adequate fixation the manual human heart and their branching characteristics have been dissection was done. the subject of particular attention among researchers. Coronary artery anomalies are a diverse group of The composition of preservative fluid congenital disorders whose manifestations and Formalin -------------- 2 liters pathophysiological mechanisms are highly variable Glycerin -------------- 1 liter (Angelini et al., 2002). The subject of coronary artery Absolute Alcohol -------------- 1 liter anomalies is undergoing profound evolutionary changes H2O -------------- 2 – 4 liters related to the definition, morphogenesis, clinical Salt -------------- 1kg presentation, diagnostic workup, prognosis and treatment of these anomalies. Manual Dissection According to (Engel, 1975), 1-2% of patients Manual Dissection was done in 50 heart studied by selective coronary arteriography, one or more specimen. major elements of the coronary arterial system originated from the sinuses of valsalva in an ectopic manner. The Procedure for Dissection of RCA &LCA failure to recognise variations in coronary arterial origin Materials used can prolong arteriographic procedures and lead to errors in Gloves interpretation of coronary artery anatomy and pathology. Mosquito scissors - 2. Though a number of recent techniques namely Mosquito forceps (toothed) - 2. Electron Beam Computerized Tomography (EBCT), 64 Mosquito artery forceps - 2. slice CT (Angio, 2005) and intravascular ultrasound have The visceral pericardium from the sternocostal of been introduced, selective coronary arteriography remains the heart. Expose the anterior interventricular branch of the the clinical “Gold Standard” for evaluating coronary left coronary artery and the great cardiac vein by scraping 356 Venugopal GE. et al. / International Journal of Biological & Pharmaceutical Research. 2016; 7(11): 354-359. the fat from the anterior interventricular sulcus. Note the surface of the heart to the sternum and costal cartilages. branches of the artery to both ventricles and to the interventricular septum which lies deep to it. Trace the RESULTS artery inferiorly to the diaphragmatic surface and Classified on the basis of segmental branches superiorly to the left of the pulmonary trunk. Branches of RCA are from first segment which Carefully remove the fat from the coronary extends from anterior