The human hart is in most cases vascularized by two coronary arteries, the right and the left one. Supernumerary or added coronary arteries are also present sometimes. The aim of this paper is to ascertain presence of supernumerary coronary arteries that arise directly from aorta, their frequency, flow, way of branching, and possibly their anastomoses with other coronary arteries. Out of 25 hearts, examined by dissection, 8 of them (32%) had conal artery. According to our opinion, the most suitable term for this artery, in order to differ it clearly from the conal branch of the right coronary artery, is third coronary artery. One heart (4%) had four coronary arteries. Both supernumerary coronary arteries arose from the right aortic sinus. The third coronary artery represents a significant way of collateral coronary circulation, as it frequently anastomoses with anterior interventricular branch.
The aim of the investigations was to demonstrate different types of collaterals of coronary arteries using the method of coronary angiography and injection-corrosion method. The investigations were carried out on 30 human cadaveric hearts from the Department of Anatomy, and 30 angiograms of patients from the Cardiology Department of Clinics Centre in Sarajevo. Clinical investigations were retrospective and prospective on patients that were treated in hospital, and on patients that just arrived in hospital (based on findings of coronary angiography). The results show the existence of different types of collaterals: intercoronary and intracoronary. We established collaterals in a case with occlusion of the right coronary artery and left coronary artery in which better development of collaterals was established. Our patients were classified in two groups: 1) Patients with good collaterals and good left ventricular function; 2) Patients with good collaterals and impaired left ventricular function. On the anatomical material we found different types of collaterals as well. Our results show that coronary angiography is useful diagnostic method for the demonstration of coronary collaterals.
Proficiency in the anatomy of coronary arteries and their variations is significant for proper interpretation of the coronary angiographies, assessment of the complexity and result of the coronary insufficiency as well as surgical myocardium revascularization. The objective of this study is anatomy-radiology research of the methods of branching the main trunk of left coronary artery and to prove importance of the diagonal branch (ramus diagonalis) existence in the conditions of coronary insufficiency. In this study we have analyzed 100 coronary angiographies done at the Clinic for Heart Diseases and Rheumatism of the Clinic Center of University of Sarajevo and dissected 20 human hearts from the Institute of Anatomy. In our study we have come upon two methods of branching of main trunk of left coronary artery (bifurcation and trifurcation). By the method of the angiography we have found the bifurcation in 71% of cases while 65% of cases were proved by the dissection method. Trifurcation has been discovered in 29% of cases of analyzed angiographies i.e. 35% of cases of dissected hearts. We believe that third terminal branch of the left coronary artery should be marked as ramus diagonalis. This branch, including its anastomoses, presents important pattern of the collateral blood flow, which has special meaning, under conditions of coronary insufficiency.
Variations of the human coronary arteries have always attracted the attention of many researchers. A review of the literature shows that variations can cause ischemic heart disease or sudden cardiac death. The aim of the investigations was to examine the existence and clinical significance of variations of the human coronary arteries. Special attention has been focused on myocardial bridging of the coronary arteries and coronary arteriovenous fistula. Our investigations were carried out on the human hearts at the Department of Anatomy and on patients at the Cardiology Department of University Clinical Centre in Sarajevo. Using the method of dissection and coronary angiography we established the existence of variations of the coronary arteries (variations of origin, distribution) on the human hearts without macroscopic visible changes as well as on patients with ischemic changes (angina pectoris, myocardial infarction, congenital cardiovascular malformation etc.). We established the higher incidence of ischemic changes on patients with variations of coronary arteries.
We used injection and corrosion method to study path, caliber and branching of anterior and middle cerebral artery, which supplies anterior two thirds of medial and external surface of cerebral hemispheres and associated subcortical structures. When we studied our specimens, we observed that internal carotid artery always bifurcates and gives anterior and middle cerebral artery. Precommunicant segment of anterior cerebral artery has variable appearance. In 65 percent this path of anterior cerebral artery is arch shaped with convexity laterally and forward, but in 44 percent it is straight and oblique in direction. We observer that in 1 percent of cases precommunicant segment of anterior cerebral artery has wavey path. In one percent of the cases anterior third of pericallosal artery is branching from anterior communicating artery. This third pericallosal artery is smaller than the other pair of pericallosal arteries branching from anterior cerebral artery. Initial segment of middle cerebral artery(pars sphenoidalis) is 2.5 cm long. In 70 percent of cases terminal part of sphenidal segment of middle cerebral artery bifurcates, in 30 percent of cases we studied this segment trifucates. Insular segment of the middle cerebral artery branches into several segments which are narrower. When we studied our specimens we found one rare variation branching from middle cerebral artery where it bifurcated into anterior smaller and posterior larger branch, than they divide into multiple smaller branches in periinsular segment.
We have investigated the intramural blood vessels of the A-V segment in the conductive system of 20 human hearts using the method of light microscopy. The results of our study have shown that the A-V segment of the conductive heart muscles in human hearts has an abundant vascularisation. We have found the greatest density of the intramural net in the dorsal part of the A-V node; this density of blood vessels decreased toward the Hiss' bundle. After comparing these results with the earlier findings in the study of the intramural net in the S-A system we have found that A-V segment of the conductive heart system has a poorer blood supply in regard to S-A system. We have also found that the intramural net of blood vessels is weaker in the adjacent ventricular parts and in the interventricular septum. It cannot be said that there exists any surface vascular zone subepicardial, middle and deep sub-endocardiac--in the A-V segment of the conductive system of human heart.
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