Main trunk of the left coronary artery: anatomic study of the parameters of clinical interest

The objective of this study was to analyze in one single series all the characteristics of the main trunk of the left coronary artery (MT) that may be of use in the diagnosis and treatment of its pathologies. One-hundred human hearts from autopsies were used. The average age of the sample studied was 63.15 years +/- 18.76 (range = 17-94 years). The heart was removed after resection of the costosternum and placed in 10% formaldehyde. With gradual separation and retraction of the myocardial fasciculi the MT was exposed. The length of the MT, the luminal diameter of the MT at its midpoint, and the luminal diameter of the left coronary orifice were measured with a caliper. The angle of division between the anterior interventricular and circumflex branches was also measured, and the number of terminal branches originating from the MT was recorded. In four cases, there was no MT and the anterior interventricular and circumflex branches originated directly from the left aortic sinus. The average length of the MT was 10.8 +/- 5.52 mm (range = 2-23 mm); the average diameter at its midpoint was 4.86 +/- 0.80 mm; and there was no significant difference noted between the midpoint diameter of the MT and the diameter of the left coronary orifice. The most frequent type of division of the MT was bifurcation (62%); in 38% of cases the MT divided into three or more branches. An average value of 86.7 +/- 28.8 degrees was obtained for the angle of division of the terminal branches of the MT (range = 40-165 degrees ). There was a positive correlation between the length of the MT and the angle of division of its terminal branches, with the longest MTs having the largest angle of division.     

The ultrastructure of the various forms of pulmonary arterial intimal fibrosis

Summary Intimal fibrosis of muscular pulmonary arteries may present in various forms and in varying degrees of severity according to the underlying condition. In patients with pulmonary hypertension, the type of intimal fibrosis is often significant with regard to prognosis and reversibility. For these reasons we have studied the ultrastructure of the thickened intimal layer in aged individuals, where intimal fibrosis occurs as a normal age change, and in patients with pulmonary hypertension associated with fibrosis of the lungs, mitral stenosis, chronic pulmonary thromboembolism and plexogenic pulmonary arteriopathy (either primary or secondary to congenital cardiac defects). In all these forms of intimal fibrosis, the cellular component of the subendothelial intimal layer was apparently almost exclusively the smooth muscle cell.These cells usually had a haphazard arrangement. In primary and secondary plexogenic pulmonary arteriopathy, however, there was a more regular circumferential arrangement. The ultrastructural evidence suggested that the intimal cells were derived from medial smooth muscle cells.     

肺动脉修复与重建的应用解剖学

目的 :为肺动脉修复与重建提供解剖学基础。方法 :对 3 0例成人尸体肺动脉心包外段的长度、外径、分支及奇静脉各段的长度、外径进行观测。结果 :左、右肺动脉出心包返折处的外径分别为 (13 .8±2 .6)mm ,(15 .3± 2 .8)mm ;发出下叶上支处的外径分别为 (8.4± 2 .1)mm ,(9.1± 2 .3 )mm。左、右肺动脉出心包处至下叶上支动脉起点处长度分别为 (4 .9± 0 .6)cm ,(3 .8± 0 .8)cm。奇静脉第 2段、第 3段 (奇静脉弓 )的长度分别为 (4 .2± 0 .9)cm ,(3 .1± 0 .6)cm。结论 :(1)如肿瘤侵犯肺动脉主干及其分支根部 ,动脉切除后可采用袖式吻合及侧壁扩大成形术 ;(2 )如右肺动脉侧壁切除缺损较大时 ,首选自体奇静脉片进行重建。     

Small pulmonary arterial vessels of Aymara Indians from the Bolivian Andes

A study was made of the qualitative histological features of the small pulmonary arterial vessels of 25 adult citizens of La Paz, Bolivia (altitude 3600 m) coming to necropsy. Abnormalities found included muscularization of pulmonary arterioles, the development of longitudinal muscle in the intima of pulmonary arteries and arterioles, and the formation of muscular tubes lining the longitudinal muscle which extended through arterioles into the precapillaries of the lung. Arteriolar muscularization was found in three of the 13 Aymaras and in two of the 12 Mestizos studied. Intimal longitudinal muscle was present in four Aymaras and five Mestizos. Muscular tubes were found in only one case, a young Aymara. The features were very similar to those found in chronic obstructive airways disease. The appearances are consistent with a growth of new vascular smooth muscle in response to alveolar hypoxia as opposed to hypoxic vasoconstriction.     

RhoA/Rho激酶信号通路与肺动脉高压

目前研究已发现RhoA/Rho激酶信号通路参与了人体多种疾病的形成,如高血压、冠心病、脑率中等.肺动脉高压的病理学改变包括内皮细胞的损伤、增殖,肺血管平滑肌细胞的高反应性,炎症细胞迁移和黏附以及肺小血管形成和栓塞;Rho激酶调节细胞的多种生物学行为和功能,如收缩、黏附、迁移、增殖、凋亡、基因表达等.研究表明RhoA/R...     

自制可调节肺动脉环缩装置对右心室作用实验研究

目的通过对动物右心室作用实验的研究,验证自制可调节肺动脉环缩装置的有效性。方法 12只健康雄性小尾寒羊,5～6个月龄,体质量26～37kg。随机分为实验组和对照组,每组各6只,体质量分别为（29.00±2.78）kg和（28.36±4.24）kg,差异无统计学意义（P=0.722）,从左侧第二肋间进胸,游离肺动脉主干,置入自制可调节肺动脉环缩装置,向球囊内注入0.9%NaCl溶液,逐渐增加右心室压力,进行心室训练,达到训练标准所需时间为9～18d。观察超声下右心室形态、血流动力学及心肌组织病理学变化。结果超声下右心室形态、室间隔位置、游离壁厚度均较训练前发生明显改变;血流动力学结果表明右心室/左心室收缩压力比值大于0.6,达到临床上心室训练的标准;右心室的收缩功能（P〈0.05）和舒张功能（P〈0.001）均得到了增强;病理检查结果右心室游离壁厚度及质量、右心室肥大指数、心肌细胞横径与对照组比较差异存在显著统计学意义（P〈0.001）。结论该装置能够达到肺动脉环缩、训练心室的目的 ,并且可双向调节,使用方便,效果可靠。     

Coexistence of multiple anomalies in the celiac-mesenteric arterial system

The origins and distribution of arteries of the celiac-mesenteric system were examined by dissection of 52 formalin-fixed human cadavers. Seventy-five percent of the cadavers exhibited the classic Michels' Type I hepatolienogastric pattern; 25% had different branching patterns. Multiple anomalies of the celiac-mesenteric arterial system were observed in one Caucasian female cadaver: a short lienogastric trunk; a common hepatic artery arising directly from the abdominal aorta; an anomalous course of the hepatic arteries; an accessory left hepatic artery arising from the left and right gastric arterial anastomosis along the lesser curvature of the stomach; a double cystic artery; a common inferior phrenic trunk arising from the celiac trunk; and an aberrant arterial channel connecting the proximal segments of the splenic and gastroduodenal arteries. A patent ductus venosus and an anomalous formation of the portal vein by the confluence of the splenic and superior and inferior mesenteric veins was also observed. Although single anomalies of the celiac-mesenteric arterial system are common, complex combinations, such as were observed in the present case, represent a significant deviation from the normal developmental pattern. There seems to be no report in the literature of such a combination of anomalies coexisting in one individual. The developmental and clinical significance of these anomalous vessels is discussed.     

Rare coronary anastomoses between the aorta,pulmonary trunk,left coronary artery,and subclavian artery

We report a rare case of coronary anastomoses in an 83‐year‐old male cadaveric heart. Anomalous vessels arose from the right sinus of the aorta, left main coronary artery, left anterior descending artery, left anterior medial atrial artery, and left subclavian artery. These vessels bifurcated and anastomosed, and finally connected to the pulmonary trunk. The present case is categorized as a multilateral coronary artery fistula in cardiology. Clin. Anat. 25:969–972, 2012. © 2012 Wiley Periodicals, Inc.     

肺腺泡内动脉构形重建与肺动脉高压等的关系

以野百合碱一次性皮下注射复制大鼠肺动脉高压和肺心病模型。应用光镜、电镜、免疫组织化学和形态定量等方法，观察了肺腺泡内动脉不同病变在肺动脉高压中的作用。结果表明了肺循环功能与结构之间的关系，反映出肺腺泡内动脉构形重建是肺动脉高压形成的病理学基础。结果提示肺腺泡内动脉壁周细胞的增生和肌样分化，对无肌型肺动脉的肌化意义重大。     

Morphometric study of the pulmonary trunk implications for a new approach of the Ross procedure

A pulmonary valve autograft may be proposed to replace diseased aortic valves. The explanted pulmonary valve is replaced with a pulmonary homograft with the inherent risk of calcified degeneration. A monocusp valve using the anterior pulmonary trunk has been proposed to reconstruct the right ventricular outflow tract. The aim of this study was to determine the feasibility of this technique. In hearts from 17 adult cadavers, we measured pulmonary trunk diameter at the leaflet tops (D1). H1 and H2 were respectively from leaflet top to lower and upper levels of the pulmonary trunk bifurcation. D2 = 1.4 D1 was calculated as the monocusp size allowing a 45∘ opening of the valve and thus permitting good valvular efficacy. G = H1-D2 determined the feasibility of the technique G greater than 10 mm, appeared the most favorable, G between 0 and 10 mm, appeared possible, and G less than 0, appeared to be impossible. Mean values of D1, H1 and H2 were respectively 20.19 mm, 37 mm and 57 mm. The technique was possible in 16 cases (94%) and impossible in 1 case (6%). Preoperative determination of these parameters, by echocardiography or magnetic resonance imaging, appears necessary before applying this new surgical technique.     

The ultrastructure of plexogenic pulmonary arteriopathy

The lungs from 16 cases of plexogenic pulmonary arteriopathy obtained at heart-lung transplantation, half of which had primary pulmonary hypertension, were examined by electron microscopy. From these the probable pathogenesis of pulmonary arterial intimal fibrosis in plexogenic pulmonary arteriopathy was deduced. The earliest detectable change was migration of smooth muscle cells from the media, through the internal elastic lamina into the intima. These cells collected beneath the endothelium and lost many of their myofilaments to become myofibroblasts. They were associated with ground substance but scanty collagen fibrils. As the quantity of interstitial collagen increased, the myofibroblasts reverted to a muscular structure, became elongated, and assumed a regular, circumferential orientation. This later stage coincided with the development of plexiform lesions. At both early and later stages, the muscular pulmonary arteries were contracted but not markedly so, and muscular evaginations were not seen. On the other hand, the cellular intimal proliferations developed early and were occlusive. This suggests that occlusion of small pulmonary arterial vessels by myofibroblasts may be at least as important as vasoconstriction in the early elevation of the pulmonary vascular resistance in primary pulmonary hypertension.     

Location of the coronary arterial orifices in the normal heart

We examined the coronary arterial orifices in relation to the aortic valve to determine the range of normality in 23 normal hearts from autopsied adults. We determined the position of the zones of apposition between leaflets, the size of the leaflets, the number, position, and shape of the coronary arterial orifices, and their relation to the sinutubular junction. The aortic valve had three leaflets in all specimens, nearly equally spaced around the aorta. The left coronary artery arose within the left posterior aortic sinus (of Valsalva) in 16 (69%) specimens, above the sinutubular junction in five (22%), and at the level of the junction in two (9%). The distance of the left orifice from the zone of apposition between the left posterior and anterior aortic leaflets was between 13% and 61% of the width of the aortic sinus at the sinutubular junction. The right coronary artery arose within the anterior aortic sinus in 18 (78%) specimens, above the junction in three (13%), and at the level of the junction in two (9%). The distance of the orifice from the zone of apposition between the leaflets hinged from the anterior and right posterior aortic sinuses was between 5% and 62% of the width of the aortic sinus at the sinutubular junction. An accessory coronary orifice was found in the anterior aortic sinus in 17 (74%) specimens, whereas a third orifice in this sinus was found in five hearts. The coronary arterial orifices are usually located within the aortic sinuses below the sinutubular junction, but are rarely centrally located. Accessory coronary arterial orifices are found in the majority of the anterior aortic sinuses. Clin. Anat. 10:297–302, 1997. © 1997 Wiley-Liss, Inc.     

The bronchial arteries: anatomic study and application to lung transplantation

Summary The bronchial arterial system (BAS) and its territory was studied in dissections of 40 fresh adult cadavers. The arterial distribution was assessed by catheterisation of the ostia and injection of contrast medium. The number of bronchial aa. varied from 2 to 4. The origin of the arteries was between the upper border of T5 and the lower border of T6 in 90% of cases. The intercostobronchial trunk was the virtually exclusively component of the right bronchial arterial system, present in 97.5% of cases. It was associated with an accessory right bronchial a. in 7.5% of cases, which was merely supplementary. A common arterial trunk for both bronchial systems was present in 50% of cases. The left BAS was characterised by the presence of a direct left bronchial a. (LBA) in 76% of cases, and by the combination of two LBAs in 20%, one of which was usually dominant. However, major anatomic networks between the different vessels found allowed reimplantation of the LBA alone in the former situation, and in the latter it was possible to rely on the dominant LBA alone when reimplantation of the different ostia was impossible. The proximity of the different ostia and the interostial interval, which was less than 1.5 cm on average, permitted multiple revascularisations by the same vascular supply.

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Les artères bronchiques : étude anatomique et application aux transplantations pulmonaires

Résumé Le système artériel bronchique (SAB) et son territoire ont été étudiés à partir de dissections portant sur 40 cadavres frais adultes. La distribution artérielle était appréciée par cathétérisme des ostiums et injection de produit de contraste. Le nombre des aa. bronchiques variait de 2 à 4. La naissance des artères s'étalait dans 90 % des cas entre le bord supérieur de T5 et le bord inférieur de T6. Le tronc intercosto-bronchique était l'élément quasi exclusif du système artériel bronchique droit, présent dans 97,5%. Une a. bronchique droite accessoire lui était associée dans 7,5% des cas; elle n'était que supplétive. Un tronc artériel commun pour les deux arbres bronchiques était présent dans 50 % des cas. Le SAB gauche était caractérisé par la présence d'une a. bronchique gauche (ABG) directe dans 76 % des cas, par une association de 2 ABG dans 20 % des cas, dont l'une était le plus souvent dominante. D'autre part, d'importants réseaux anastomotiques entre les différents vaisseaux retrouvés, permettaient dans le premier cas la réimplantation de l'ABG seule et dans le deuxième de ne compter que sur l'ABG dominante lorsque la réimplantation des différents ostiums n'était pas possible. La proximité des différents ostiums, la distance inter-ostiale qui était en moyenne inférieure à 1,5 cm, rendaient possible les revascularisations multiples par le même apport vasculaire.

     

Peculiarities of cholinergic regulation of smooth muscles in rabbit pulmonary arteries

Cholinergic contractile reactions of smooth muscles in rabbit pulmonary arteries were studied by mechanography. The muscarinic receptor agonist pilocarpine induced biphasic relaxation of mesatone- or potassium-precontracted segments from lobar pulmonary arteries with intact endothelium. The low-threshold endothelium-dependent component of pilocarpine-induced relaxation was suppressed by denudation or nitric oxide synthase blocker L-NAME. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 130, No. 8, pp. 134–136, August, 2000     

The principal pathways involved in the in vivo modulation of hypoxic pulmonary vasoconstriction,pulmonary arterial remodelling and pulmonary hypertension

Hypoxic pulmonary vasoconstriction (HPV) serves to optimize ventilation–perfusion matching in focal hypoxia and thereby enhances pulmonary gas exchange. During global hypoxia, however, HPV induces general pulmonary vasoconstriction, which may lead to pulmonary hypertension (PH), impaired exercise capacity, right‐heart failure and pulmonary oedema at high altitude. In chronic hypoxia, generalized HPV together with hypoxic pulmonary arterial remodelling, contribute to the development of PH. The present article reviews the principal pathways in the in vivo modulation of HPV, hypoxic pulmonary arterial remodelling and PH with primary focus on the endothelin‐1, nitric oxide, cyclooxygenase and adenine nucleotide pathways. In summary, endothelin‐1 and thromboxane A₂ may enhance, whereas nitric oxide and prostacyclin may moderate, HPV as well as hypoxic pulmonary arterial remodelling and PH. The production of prostacyclin seems to be coupled primarily to cyclooxygenase‐1 in acute hypoxia, but to cyclooxygenase‐2 in chronic hypoxia. The potential role of adenine nucleotides in modulating HPV is unclear, but warrants further study. Additional modulators of the pulmonary vascular responses to hypoxia may include angiotensin II, histamine, serotonin/5‐hydroxytryptamine, leukotrienes and epoxyeicosatrienoic acids. Drugs targeting these pathways may reduce acute and/or chronic hypoxic PH. Endothelin receptor antagonists and phosphodiesterase‐5 inhibitors may additionally improve exercise capacity in hypoxia. Importantly, the modulation of the pulmonary vascular responses to hypoxia varies between species and individuals, with hypoxic duration and age. The review also define how drugs targeting the endothelin‐1, nitric oxide, cyclooxygenase and adenine nucleotide pathways may improve pulmonary haemodynamics, but also impair pulmonary gas exchange by interference with HPV in chronic lung diseases.     

儿童肺动脉狭窄气囊扩张术有关应用解剖

在31具2～6岁儿童尸体上,观测了气囊扩张肺动脉狭窄术有关的应用解剖学数据.肺动脉瓣环上下缘横径分别是11.2mm、13.9mm,前、左、右瓣膜高分别是8.0mm、7.8mm和7.6mm.观测了与扩张术相关的股血管、髂外血管及髂总静脉等,为临床实施该术提供了应用解剖学依据.     

The infra-optic course of the anterior cerebral arteries: an anatomic case report

Although variations of the anterior part of the cerebral arterial circle of Willis are quite well known, though some anomalies are exceedingly rare. In a 61-year-old female individual, on both sides the precommunicating parts of the anterior cerebral artery were found to course inferiorly to the ipsilateral optic nerves. This anomaly was associated with an agenesis of a left posterior communicating artery. The anatomic features, the possible high prevalence of associated aneurysms of the anterior communicating artery complex as well as implications for surgical planning or endovascular treatment are outlined and embryologic considerations and discussed.     

The spinoglenoid ligament: an anatomic study

The spinoglenoid ligament and its anatomic variations are described in 27 shoulders from 15 cadavers. In each shoulder one or two distinct spinoglenoid ligaments originated from the base of the spine of the scapula; they inserted on the neck of the scapula or the shoulder joint capsule. In the 19 shoulders in which only one spinoglenoid ligament was present, it inserted into the neck of the scapula in 14 cases and into the shoulder joint capsule in five instances. In the eight shoulders in which there were two ligaments, one inserted into the neck of the scapula and the other into the shoulder joint capsule. We did not observe any hypertrophic spinoglenoid ligaments that may have compressed the suprascapular nerve.     

An homozygous mutation in KCNK3 is associated with an aggressive form of hereditary pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a rare devastating disease characterized by a high genetic heterogeneity with several related genes recently described, including BMPR2,TBX4 and KCNK3. The association between KCNK3 and PAH has been recently identified, but the prognosis and phenotype associated with these mutations have been poorly described. We studied a series of 136 idiopathic and hereditary PAH Spanish patients for BMPR2, TBX4 and KCNK3 mutations. We report the results of KCNK3 in which we were able to describe two new mutations (p.Gly106Arg and p.Leu214Arg) in three patients. The first one was found in a patient belonging to a consanguineous Romani family, who carried a homozygous mutation in KCNK3 and developed a severe and early form of the disease. To the best of our knowledge, this is the first time that a homozygous mutation in KCNK3 is reported in a PAH patient. The second one was found in a patient who presented at the young adult age a severe form of the disease. The present report supports the contribution of KCNK3 mutations to the genetic etiology of PAH and strongly suggests that mutations in KCNK3 follow incomplete dominance with worsening of the clinical features in homozygous patients.