Abstract
OBJETIVO: O objetivo deste trabalho é a descrição dos ramos lateral, diagonal e ântero-superior, no tecido adiposo epicárdico do ventrículo esquerdo, e a análise da freqüência e do diâmetro destes, conforme o tipo de circulação coronariana. O conhecimento preciso desses ramos tem aplicabilidade na abordagem cirúrgica para a sua revascularização ou durante a injeção de substâncias cardioplégicas nos mesmos. MÉTODO: Dissecados 50 corações obtidos de necropsias de adultos, fixados em solução de formol e o ventrículo esquerdo dividido em três terços: superior, médio e inferior. O ramo lateral originou-se do ramo circunflexo; o ramo diagonal, do ponto de divisão da artéria coronária esquerda e o ramo ântero-superior, do ramo interventricular anterior no terço superior do ventrículo esquerdo. Para cada ramo foram medidos o comprimento no epicárdio e o diâmetro, além disso foi relacionado o fluxo sangüíneo com o tipo de circulação coronariana. RESULTADOS: O diâmetro do ramo lateral, presente em 88% dos casos, variou de 0,6 a 4,5 mm (média 2,1 ± 0,7mm). O diâmetro do ramo diagonal, presente em 50% dos casos, variou de 1,0 a 3,8 mm (média 2,2 ± 0,7 mm). O diâmetro do ramo ântero-superior, presente em 84% dos casos, variou de 1,0 a 4,1 mm (média 2,5 ± 0,8 mm). Foram encontrados: 30/50 (60%) casos de dominância da artéria coronária direita, 14/50 (28%) casos de tipo balanceado e 6/12 (12%) casos de dominância da artéria coronária esquerda. A média do fluxo sangüíneo do ramo ântero-superior apresentou valor decrescente nos tipos: dominância da artéria coronária direita, balanceado e dominância da artéria coronária esquerda. Inversamente, o ramo lateral mostrou valor crescente, enquanto o ramo diagonal apresentou maior fluxo no tipo balanceado. CONCLUSÃO: Os resultados demonstraram a complementaridade entre os ramos lateral, diagonal e ântero-superior, bem como a correlação entre a distribuição dos mesmos e os tipos de circulação coronariana.
Highlights
IntroductionLet us present the concepts adopted in respect to the coronary artery branches of the anterior face of the left ventricle, the focus of the present study.The lateral branch originates from the circumflex branch of the left coronary artery, before the root of the left marginal branch.The diagonal branch is one of the terminal branches of the left coronary artery, as well as the circumflex and anterior interventricular branches, when it splits into three or four branches.The anterosuperior branch of the left ventricle is the one that originates from the anterior interventricular branch in the upper third of the left ventricleDetailed knowledge about the coronary artery branches has already been greatly studied, further study is necessary due to incessant advances in the diagnosis and treatment methods of heart diseases [1,2,3]
The results demonstrated the complementarity of the lateral, diagonal and anterosuperior arterial branches, as well as the correlation among these branches with the following types of coronary circulation: right dominance, balanced and left dominance
Let us present the concepts adopted in respect to the coronary artery branches of the anterior face of the left ventricle, the focus of the present study
Summary
Let us present the concepts adopted in respect to the coronary artery branches of the anterior face of the left ventricle, the focus of the present study.The lateral branch originates from the circumflex branch of the left coronary artery, before the root of the left marginal branch.The diagonal branch is one of the terminal branches of the left coronary artery, as well as the circumflex and anterior interventricular branches, when it splits into three or four branches.The anterosuperior branch of the left ventricle is the one that originates from the anterior interventricular branch in the upper third of the left ventricleDetailed knowledge about the coronary artery branches has already been greatly studied, further study is necessary due to incessant advances in the diagnosis and treatment methods of heart diseases [1,2,3]. Let us present the concepts adopted in respect to the coronary artery branches of the anterior face of the left ventricle, the focus of the present study. The lateral branch originates from the circumflex branch of the left coronary artery, before the root of the left marginal branch. The diagonal branch is one of the terminal branches of the left coronary artery, as well as the circumflex and anterior interventricular branches, when it splits into three or four branches. The anterosuperior branch of the left ventricle is the one that originates from the anterior interventricular branch in the upper third of the left ventricle. This work is justified as, according to Oliveira et al [4], the diagonal, lateral and anterosuperior branches are important, due to the frequent use of their epicardial sections in coronary artery bypass surgery, as well as the internal thoracic artery and the saphenous vein. Among the authors who have researched the subject of the diagonal, lateral and anterosuperior branches of the left ventricle, we must mention: Bianchi [5], Crainicianu [6], Smith [7], James [8], De Paula [9], Mac Alpin et al [10], Gensini et al [11], Kalbfleisch & Hort [12], Carvalho [13], Leguerrier et al [14], Di Dio & Rodrigues [15], Henriquez Pino et al [16] and Baptista et al [17]
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