Normal Coronary Artery Anatomy Research Articles

Spontaneous angina during serial resting thallium-201 myocardial scintigraphy

severely narrowed by an atherosclerotic plaque. These investigators suggested that the significance of such stenosis of the “right main” coronary artery was equivalent to that of critical narrowing of the LMCA in patients with normal coronary artery anatomy, and termed this lesion “the true left main equivalent.” To our knowledge, antemortem diagnosis and treatment of right main coronary artery stenosis has not previously been reported. In our patient, the LCX artery was small; indeed, much of the left ventricular myocardium normally supplied by the LCX was supplied by the unusually large RCA rather than by the anomalous LCX itself. It is evident that the superiority of surgical over medical therapy for right main coronary artery disease will not be demonstrated by a randomized, controlled study, as it has for LMCA disease4; we feel, nevertheless, that the analogy with LMCA disease is compelling enough to warrant coronary artery bypass surgery in patients with significant right main coronary artery stenosis.

The Anginal Syndrome With Normal Coronary Arteries

THE INCREASING application of coronary angiography to the evaluation of patients with angina pectoris has led to the identification of a group of patients who experience anginal-type chest pain despite the presence of normal coronary artery anatomy by arteriography. Indeed, such patients may constitute up to 20% of those who have undergone elective coronary arteriography for suspected coronary artery disease.1Although initially believed to be primarily an affliction of women, the syndrome has been detected with increasing frequency in men and in some studies has been found to be equally prevalent in both sexes. Despite the presence of normal coronary arteries, persons with this syndrome may have major functional impairment. They may often require hospitalization for chest pain evaluation and management and may even present a condition of unstable angina. Recently, coronary artery spasm has been demonstrated to be responsible for many chest pain syndromes, including variant angina pectoris,

Caliber and distribution of normal coronary arterial anatomy.

Selective coronary arteriograms of 125 patients with normal coronary arteries were reviewed to establish the caliber and distribution of normal coronary arterial anatomy. Measurements established the following normal values for coronary arterial caliber in right (R), (M), and left (L) inferior emphasis systems expressed in mm (+/-SEM): (See article). Significant differences in the caliber of right coronary arterial systems and left circumflex coronary arterial systems validate the separation of coronary arterial anatomy into right, mixed, and left inferior emphasis systems, depending upon the blood supply to the inferior wall of the left ventricle. Classification of the anatomical pattern into right, mixed, and left inferior emphasis systems is useful in the cardiac catheterization laboratory at the time of selective coronary arteriography. If the expected distribution of the coronary vessels is not found, then missing vessels must be sought out. A knowledge of the range of normal size for the coronary arterial tree should be of value in defining the severity of coronary arterial narrowing.

A clinically useful coding system for normal coronary artery anatomy.

Cine coronary arteriograms of 121 patients with normal coronary arteriograms with and without associated valvular or myocardial disease were reviewed to describe normal coronary artery anatomy and the distribution of potentially graftable vessels. Coronary arterio grams were divided into right, mixed, and left interior emphasis systems, depending upon the blood supply to the inferior surface of the left ventricle. Whether a coronary artery at its origin was less than 50%, between 50-70% of the left anterior descending coronary artery (LAD) at its origin was described in a simple lettering and numbering code to allow easy comparison. The diameter of the LAD at its origin averaged 4.2 mm. All vessels greater than 70% of the LAD were clearly graftable. The frequency (in percent) with which that vessel was greater than 70% of the LAD in right, mixed, and left systems, respectively, was as follows: right coronary artery 100. 100. 0. LAD 100. 100. 100. intermediate artery 8.7 12.5 33.3 obtuse marginal artery 53.7 43.7 44.4 atrioventricular groove artery 0. 56.2 100. diagonal branch of the LAD 15. 6.3 11.1. This simple method of classification is recommended to provide more accurate comparison in published series and to assist the coronary arteriographer in his interpretations.

Coronary Angiography

The increasing volume of coronary artery surgery being performed in institutions large and small has required that the skills of coronary angiography be more widely disseminated. This monograph addresses itself to that need. An attempt has been made to discuss all aspects of the subject including history, roentgenographic and catheterization equipment and techniques, normal and anomalous anatomy, diseases of the coronary arteries, and complications of angiography. The book is most successful in its discussion of the normal roentgenographic coronary artery anatomy. It is difficult to find the information concontained in this section between the covers of any other text. The long discussion of atheromatous disease and collateral pathways in obstructive disease is also to be highly recommended. The illustrations are of high quality and the many line drawings are superb. Less successful is the discussion of roentgenographic equipment and catheter technique. The authors err, I believe, in recommending specific products

Anatomy of the coronary arteries in health and disease.

This is a brief perspective review of some personal observations on the normal and abnormal anatomy of the human coronary arteries. Since it is possible to cover in detail but a few aspects of such a broad subject, the presentation was oriented to stress topics of special value to the physician dealing with patients having heart disease.