Total anomalous origin of the coronary circulation from the right pulmonary artery

Origin of both coronary arteries from a branch of the pulmonary artery is rare and has not been reported as a cause of sudden unexpected death. We report autopsy findings of a 14-day male infant in previously good health who died suddenly. From the proximal right pulmonary artery arose a single coronary artery, which branched into the right and left main coronary arteries. The right proximal coronary artery coursed between the aorta and pulmonary trunk, and the left main traveled along the anterior proximal aorta. The distal course of the coronary circulation was normal. There was concentric subendocardial healing myocardial infarction. No other congenital anomalies were identified. Total anomalous origin of the coronary arteries from the pulmonary trunk or artery should be considered in cases of sudden unexpected death in infants.     

Platelet deposition in rabbit common carotid arteries promoted by arterial stenosis and spasm

Coronary arteriograhy in patients with ischemic heart disease often shows spasm of the coronary arteries. The question is whether spasm is a triggering factor for thrombosis in a stenotic artery. If so, what are the mechanisms for this? A stenosing teflon ring was applied to the right common carotid artery of anesthetized rabbits and l‐nor‐epinephrine was dripped over the outer surface of both carotid arteries, causing spasm. In control animals an indifferent solution did not cause spasm. Nineteen rabbits were killed 30 min or 24 h after treatment. Microscopically, arteries with stenosis and spasm contained thrombi nearby the stenosis significantly more often than arteries in control animals. In another 14 rabbits, killed at 30 min, the number of platelets on the intimal surface away from the stenosis was quantified. In arteries with both stenosis and spasm the counts were significantly greater than in arteries with no treatment. The intimal surface in stenotic and spastic arteries showed assumed imprints of eddying flow and endothelial injury downstream and upstream of the stenosis. Spastic arteries showed increased folding of the internal elastic membrane, altered endothelial cells, and adhering platelets. Spasm in a rabbit artery with a preformed stenosis facilitates thrombosis probably by creating increased flow disturbances. Spasm may induce endothelial injury, causing adherence of platelets.     

ANGIOGRAPHIC, HISTOMETRIC AND HISTOPATHOLOGICAL STUDIES ON THE INTRAMURAL CORONARY ARTERIES IN THE INFARCTED HEART

Arterial changes of the intramural branches of the coronary arteries were studied angiographically, histometrically and histopathologically in the heart obtained at autopsy from 50 cases with myocardial infarction and 21 control subjects. Stenosis was observed in 14.4% of the intramural coronary arteries in the infarction group, 3.0% in the aged and 0% in the young control group. Hypertrophy of the media was observed in 18.9% of the intramural coronary arteries in the infarction group and 10.7% in the control group. Proliferation of the internal elastic lamina was observed in 6.9% of the intramural coronary arteries in the infarction group and 0.9% in the control group. Stenosis of the intramural branches was the most frequent in those less than 300 p in diameter and was caused by muscular hypertrophy of the media. Histological changes in the vascular wall of the intramural coronary artery was less frequent in the distal to the epicardial branches with marked stenosis than distal to the epicardial branches without stenosis. ACTA PATH. JAP. 27: 511˜526, 1977.     

Compensatory enlargement of human atherosclerotic coronary arteries

Whether human coronary arteries undergo compensatory enlargement in the presence of coronary disease has not been clarified. We studied histologic sections of the left main coronary artery in 136 hearts obtained at autopsy to determine whether atherosclerotic human coronary arteries enlarge in relation to plaque (lesion) area and to assess whether such enlargement preserves the cross-sectional area of the lumen. The area circumscribed by the internal elastic lamina (internal elastic lamina area) was taken as a measure of the area of the arterial lumen if no plaque had been present. The internal elastic lamina area correlated directly with the area of the lesion (r = 0.44, P less than 0.001), suggesting that coronary arteries enlarge as lesion area increases. Regression analysis yielded the following equation: Internal elastic lamina area = 9.26 + 0.88 (lesion area) + 0.026 (age) + 0.005 (heart weight). The correlation coefficient for the lesion area was significant (P less than 0.001), whereas the correlation coefficients for age and heart weight were not. The lumen area did not decrease in relation to the percentage of stenosis (lesion area/internal elastic lamina area X 100) for values between zero and 40 percent but did diminish markedly and in close relation to the percentage of stenosis for values above 40 percent (r = -0.73, P less than 0.001). We conclude that human coronary arteries enlarge in relation to plaque area and that functionally important lumen stenosis may be delayed until the lesion occupies 40 percent of the internal elastic lamina area. The preservation of a nearly normal lumen cross-sectional area despite the presence of a large plaque should be taken into account in evaluating atherosclerotic disease with use of coronary angiography.     

Observations on detailed histology of the internal thoracic artery and their relevance to its comparatively low incidence of atheroma

The internal thoracic artery (ita) is of value as a coronary artery bypass graft. It is much less prone to develop atheroma than coronary arteries and much less prone to develop graft occlusive disease than the alternative saphenous vein graft, but the reasons for its comparative resistance to atheroma are unclear. We have sought to define the detailed structure of the artery along its length and have shown that the media of the artery changes from an elastic structure in its proximal part to a muscular one in its distal part. The internal elastic lamina has a well-defined structure at all levels, in contrast to the external elastic lamina which becomes well defined only in its distal part. The significant difference in the structure of the media of the ita, compared to that described for the coronary arteries, may be relevant to the observed difference in atheroma between this artery and the similarly sized epicardial coronary arteries. © 1994 Wiley-Liss, Inc.     

Dilatation of the coronary arteries and coronary heart disease in middle and old age

The study of the main coronary arteries dilatation of 500 patients who died from different forms of coronary heart disease in the advanced and senile age is performed. Combined coronarographic and WHO standard anatomical method as well as a back-sight morphometrical analysis were used. It is established that the dilatations of main coronary arteries are of a focal-segmentary type with a decreasing frequency of a segmental damage in a distal direction. The anterior interventricular branch of the left coronary artery is most liable to dilatation. Close correlation between the main coronary arteries dilatation and myocardial infarction in aged and senile persons are revealed.     

Impaired flow-mediated vasodilation of epicardial coronary artery in vasospastic angina.

To evaluate whether the flow-mediated vasodilation and coronary flow reserve are impaired or not in patients with vasospastic angina (VA), we measured the changes of epicardial coronary artery diameter and flow reserve in spasm related-left anterior descending coronary artery (LAD). The flow mediated-response of epicardial coronary arteries in 15 VA were compared with 15 controls. Using quantitative coronary angiography, we measured the diameter of proximal (pLAD) and middle segment (mid-LAD) of LAD under baseline conditions, during increased blood flow after distal adenosine injection and after proximal administration of nitroglycerin. An increased fraction of average peak velocity after injection of adenosine was similar in both groups [control 340 (mean)+/-24 (SEM)%; VA 330+/-19%]. Flow-mediated vasodilation was preserved in all controls (pLAD 13.1+/-1.4%; mid-LAD 15.8+/-2.5%) but it was significantly impaired in patients with VA (pLAD -1.0+/-1.8%; mid-LAD 0.1+/-3.5%). The vasodilator response to nitroglycerin was comparable in controls (pLAD 25.8+/-2.8%; mid-LAD 27.2+/-2.8%) and VA (pLAD 26.2+/-5.2%; mid-LAD 26.7+/-3.5%). Coronary flow reserve is preserved in patients with VA. However, the flow-mediated response of spasm related-epicardial coronary artery is impaired. This may play an important role in the pathogenesis of coronary artery spasm.     

16层螺旋CT冠状动脉图像质量评估

目的量化评估16层螺旋CT冠状动脉各分支图像质量,探讨冠状动脉CT成像的临床应用效果。方法采用16层螺旋CT对102例患者行回顾性心电门控冠状动脉成像,男60例,女42例,平均年龄（57．8±9．4）岁,平均心率（62．8±10．2）次／min。心率〈60次／min（n=40）为I组,60～70次／min（n=35）为Ⅱ组,〉70次／min（n=27）为Ⅲ组。4条冠状动脉分支（左主干、左前降支、左回旋支、右冠状动脉）分别用于图像质量分析。扫描原始数据以间隔10％在20％～80％时相分别回顾性重建冠状动脉图像,用横断面、曲面重建、容积再现等方法对冠状动脉显示率评估。用曲面重建方法测量冠状动脉各分支长度及近段和远段对比噪声比。结果①冠状动脉各分支平均显示长度：左主干（10．9±3．0）mm,左前降支（130．3±29．7）mm,左回旋支（82．8±19．8）mm,右冠状动脉（150．5±27．5）mm;②Ⅰ组60％和70％为最佳时相图像质量优,Ⅱ组60％时相为最佳时相图像质量优,Ⅲ组RCA较优的时相为40％,LM、LAD、LCX较优时相为60％。③所有冠状动脉分支平均对比噪声比10．9±3．2。结论16层螺旋CT有较好质量的冠状动脉图像,心率和时相影响冠状动脉的成像质量。     

The cephalic arterial system in dogs, especially on the anastomoses between the intracranial and extracranial circulations

The cephalic arterial system with a special reference to the anastomoses between the extracranial and intracranial circulations was investigated by means of the corrosion casts of 30 dogs. We researched into the cephalic arterial system in dogs according to Bugge's theory. His theory is as follows: ontogenetically it is composed of 4 arterial systems (the internal and external carotids, vertebral and stapedial arteries), although these arteries trans-figure from the primitive basic pattern to the adult one with particular anastomoses between the branches in each of the species. The modification of this basic pattern occurs as a result of the obliteration or persistence of certain parts of the 4 original arterial systems when they are accompanied with various anastomoses. And he emphasizes that the mode of the appearance of each anastomosis is constant in each of the species. In this paper the obtained result is as follows. The stapedial artery that occurred in an early stage of embryonic period obliterates the proximal part except for the supraorbital, infraorbital and mandibular branches. Anastomosis X between the vertebral and external carotid arteries is formed in all the cases. Anastomosis Y between the internal carotid and ascending pharyngeal arteries is found at 20% on the right side and 30% on the left. Anastomosis a1 between the internal ophthalmic artery and each of the orbital arteries derived from the supraorbital branch is recognized at 93% on the right side and 97% on the left, and the other a1 between the internal ophthalmic artery and anastomosis a6 is formed in 7% on the right side and 3% on the left. Anastomosis a2 between the supraorbital and infraorbital branches is recognized in all the cases. Anastomosis a3 between the distal part of the external carotid artery and the proximal portion of the mandibular branch is found out in all. Anastomosis a4 between the distal portion of the internal carotid artery and the supraorbital branch or each of its distal branches in the orbita is recognized at 90% on both sides. Anastomosis a5 between the distal part of the internal carotid artery and the proximal part of the infraorbital branch or the middle meningeal artery is found at 97% on the right side and 87% on the left.(ABSTRACT TRUNCATED AT 400 WORDS)     

Acquired coronary arterial aneurysms: an autopsy study of 52 patients

In the past decade most studies of coronary arterial aneurysms have been clinical; few have focused on morphology and etiopathogenesis. The subjects of the present autopsy study were 52 patients, 5 months to 80 years of age, with coronary arterial aneurysms. Patients were divided into two groups: 38 with atherosclerotic coronary aneurysms and 14 with aneurysms secondary to inflammation. Of the 38 patients with atherosclerotic aneurysms, 20 (53 per cent) had histories of ischemic heart disease; the aneurysms were in the right coronary artery in 18 (47 per cent), the left coronary artery in 13 (35 per cent), and in the right and left coronary arteries in seven (18 per cent). Of the four major coronary arteries, the average number of severely narrowed arteries (reduction of more than 75 per cent) in cross-sectional luminal area) was 1.8/patient; aortic aneurysms were present in eight of these patients (24 per cent). Of the 14 patients with coronary aneurysms secondary to inflammation, four had histories of ischemic heart disease; 10 had histories of an influenza-like syndrome. Isolated left coronary arterial aneurysms were seen in six of these patients (43 per cent), while eight (51 per cent) had multiple right and left coronary arterial aneurysms. The average number of severely narrowed coronary arteries in this group was 1.5/patient, and only one patient had an aortic aneurysm. Therefore, patients with atherosclerotic aneurysms are more often symptomatic; they have increased heart weights and equal numbers of coronary arterial aneurysms in the right and left vessels, and the majority (89 per cent) have single aneurysms with thrombi in the lumen. Patients with coronary arterial aneurysms secondary to inflammation are younger; the majority of these patients have a prodromal influenza-like syndrome, a low incidence of ischemic heart disease, and multiple coronary arterial aneurysms.     

Diffuse coronary arteriodysplasia in a Holstein-Friesian cow

The coronary arteries of a 6-year-old Holstein-Friesian cow showed dysplastic lesions characterized by the following vascular changes: irregular, aneurysmal dilation; intimal fibrosis associated with myointimal cells; aberrant internal elastic lamina; oedema and mast cell infiltrates; and variation in the thickness of the media, including tortuosity with irregular dilation of the lumen of the artery and a plexiform structure formed from the right coronary artery.     

尸检组织环氧合酶2、妊娠相关血浆蛋白A在冠状动脉的表达与急性冠状动脉综合征发生的关系

目的 检测急性冠状动脉综合征(ACS)发生时尸检标本中环氧合酶2(COX-2)与妊娠相关血浆蛋白A(PAPP-A)在冠状动脉局部的表达情况及两者相关性.方法 从2002-2007年尸检例中筛选出有ACS发生的21例标本作为ACS组,选择未发生ACS的标本21例作为对照组,分别取其左、右冠状动脉.以CD68标记巨噬细胞、α-肌动蛋白标记平滑肌细胞,通过对这两种细胞的标记定位PAPP-A、COX-2的阳性部位.结果 (1)COX-2及PAPP-A的阳性部位均为内皮细胞胞质、巨噬细胞胞质、平滑肌细胞胞质.COX-2在ACS组平滑肌细胞胞质的表达阳性率为28.60%,在对照组平滑肌细胞胞质阳性率为4.76%,结果表明ACS组COX-2表达明显高于对照组(x2=14.13,P<0.05).(2)在ACS发生时,COX-2与PAPP-A在冠状动脉中膜平滑肌的表达有明显的相关性(r=0.88,P<0.05).(3)非斑块处平滑肌表达PAPP-A强度明显强于斑块底部平滑肌(x2=10.36,P<0.05).结论 COX-2、PAPP-A可通过在冠状动脉局部发挥作用来参与ACS的发生.     

Origin of anterior descending coronary artery from right aortic sinus. Intramyocardial tunneling to left side of heart

We report a rare case of a coronary anomaly. All of the coronary arteries originated from a single ostium located in the right coronary cusp. The single coronary artery had a main branch corresponding to the usually dominant right coronary artery. The left anterior descending coronary artery arose from the right coronary artery and coursed intramyocardially within the right ventricular outflow tract to the anterior interventricular sulcus. The absence of evidence of myocardial ischemia in our patient, both clinically and at autopsy, and in three cases reported previously, suggests that the condition reported here was an unlikely cause of myocardial ischemia.     

A giant coronary artery aneurysm in the right coronary artery.

Aneurysms of the coronary arteries are uncommon occurrences that usually develop secondary to atherosclerosis and are often asymptomatic. They are usually diagnosed incidentally during investigation for ischemic heart disease or at autopsy for sudden death. We present a case of a "giant" right coronary artery aneurysm (CAA) discovered incidentally at surgery. Pathological examination confirmed that this was a true aneurysm showing marked thinning of the media and fibrocalcific plaques with small, multifocal areas of lymphocytic infiltrates.     

冠状动脉造影和三磷酸腺苷负荷超声心动图对川崎病冠状动脉损害远期追踪的价值

目的探讨选择性冠状动脉造影及三磷酸腺苷负荷超声心动图对川崎病（KD）冠状动脉损害远期追踪的价值。方法选取1999至2007年广州市儿童医院KD急性期超声心动图检查发现合并冠状动脉损害的患儿,同时采用三磷酸腺苷负荷超声心动图及选择性冠状动脉造影于恢复期进行远期随访。结果依据纳入标准和排除标准逐层筛选,确定9例KD患儿为本研究的样本。男8例,女1例,急性期发病年龄为1-10岁,平均（4.44±3.09）岁。检查时年龄4-12岁,平均（7.89±2.62）岁。追踪时间1.5~7年,平均（3.44±1.67）年。急性期超声心动图示9例患儿中冠状动脉巨瘤5例,冠状动脉瘤3例,冠状动脉扩张1例。三磷酸腺苷负荷超声心动图示：节段性室壁运动异常6/9例;冠状动脉血流储备下降5/9例。冠状动脉造影示：双侧主干冠状动脉瘤4例,同时伴远端动脉瘤3处,冠状动脉左前降支狭窄1处,并冠状动脉扭曲,狭窄或充盈缺损3处,附近侧支血管形成1处;左前降支动脉瘤、右冠状动脉闭塞伴侧支循环形成1例,冠状动脉扩张4例。与同期超声心动图检查比较,冠状动脉造影新发现冠状动脉远端瘤3处,右冠状动脉远端狭窄2处,左前降支狭窄1处,右冠状动脉闭塞伴侧支血管形成1例。5例三磷酸腺苷负荷超声心动图检查结果阳性者与冠状动脉造影比较：均发现相应冠状动脉支狭窄或充盈缺损表现;1例三磷酸腺苷负荷超声心动图检查结果阳性,冠状动脉造影仅见轻度冠状动脉扩张。结论KD合并冠状动脉损害特别是动脉瘤造成的心脏损害可长期存在。对于远期追踪观察KD患儿冠状动脉病变,三磷酸腺苷负荷超声心动图具无创、安全可靠的优点,是判断心肌缺血的重要方法;选择性冠状动脉造影可明确显示冠状动脉病变的位置、形态、数目及严重程度,特别对冠状动脉狭窄、闭塞及远端病变能做出准确的评估。两种方?     

Histologic study of coronary, radial, ulnar, epigastric and internal thoracic arteries: application to coronary artery bypass grafts

The biometry and the histology of coronary, radial, ulnar, epigastric and internal thoracic arteries were studied in order to investigate the cause of their occlusions in coronary bypass grafts and to improve the results of these bypass grafts. These various arteries were removed from 40 anatomical specimens (27 males and 13 females). We found a correlation between the internal calibers of the ulnar and coronary arteries in males. Intimal changes and the presence of atheromatous plaque were observed in coronary, radial and ulnar arteries, but never in the internal thoracic artery. Like coronary arteries and their branches, radial, ulnar and epigastric arteries are muscular arteries and ageing results in thickening of the intima, which becomes fibrotic with migration of myocytes from the media and duplication of the internal elastic lamina. The media becomes fibrous, hypertrophic or atrophic. In contrast, the internal thoracic artery is an elastic artery, like the aorta. Ageing is characterized by loss, over a variable extent, of one or several elastic laminae of the media and more marked intimal thickening. Although anatomically, the caliber of radial, ulnar, and epigastric arteries remains adapted to that of coronary arteries, the long-term patency of radial, ulnar and epigastric arteries used as grafts is related to their histological characteristics.     

Autopsy findings after coronary rotational atherectomy

We describe the findings at autopsy in a patient who underwent Rotablator atherectomy of the right coronary artery. During the procedure, the artery became occluded. Despite attempts to reopen the vessel with balloon angioplasty and emergency coronary artery bypass grafting, the patient developed irreversible cardiac failure and expired 2 days after the Rotablator procedure. At autopsy, the right coronary artery was found to be occluded by thrombus. No evidence of dissection or perforation of the vessel wall was seen. Small intramyocardial arteries and arterioles, downstream from the treated vessel, were embolized by pulverized atheroma.     

Right superior septal artery with "normal" right coronary and ectopic "early" aortic origin: a contribution to the vascular supply of the interventricular septum of the human heart.

In the human heart, anterior and posterior septal branches are mainly responsible for the arterial supply of the interventricular septum. These arteries are the basis of efficient intercoronary collateralization. The right and left superior septal arteries also contribute to the nourishment of the septum and to any eventual collateralization. Because the right superior septal artery (RSSA) is small in diameter, short, and has a variable origin either at the proximal stem or in the ostial area of the right coronary artery, it is difficult or almost impossible to visualize it angiographically. During investigation of the arterial supply of the interventricular septum in 84 human heart specimens and 16 corrosion casts, we found a few peculiarities in the origin and pattern of the RSSA in four specimens. The RSSA was found in 27 cases (27%); in most it was a single vessel and arose from three different locations: (a) the proximal part of the right coronary artery (21 cases); (b) the right coronary ostial area (four cases); and (c) from the floor of the right (anterior) aortic sinus (two cases). Macroscopically, in 16 cases the RSSA had a length of less than 10 mm; in nine cases the arteries were between 11 and 17 mm long. In two cases the RSSA was of more substantial appearance and up to 36 mm in length; it nourished almost the entire upper third of the septal myocardium. In these two cases, two courses could be differentiated: an extramural course with the RSSA descending to the subvalvular fibrous tissue, and an intramural course with ramification in the myocardium of the crista supraventricularis and the superior parts of the interventricular septum. One cadaveric heart specimen and one corrosion cast showed RSSAs that originated "early" (ectopically) on the floor of the right (anterior) aortic sinus; their total lengths were 16 and 17 mm, respectively. Such ectopic ostia of RSSAs have never been described before in the anatomical literature. Given the intense clinical concern with the identification of possible bypass vessels in the myocardium, we assume that the RSSA may have a potential as a collateral route. These findings were also discussed in light of developmental and comparative anatomy.     

Atresia of left coronary ostium and left main coronary artery

An uncommon coronary anomaly incidentally found at autopsy of a 76-year-old woman is reported. There was no history of cardiovascular symptoms or clinical signs of ischemic heart disease. The autopsy disclosed that the patient had no left coronary ostium and that the left main coronary artery was atretic. However, the rest of the left coronary system, including the left anterior descending coronary artery and the left circumflex coronary artery, were intact in their normal positions. Arterial flow to the left coronary system was supplied by a dilated collateral vessel that originated from the right main coronary artery and coursed between the right ventricular infundibulum and the aorta. Our case suggests that atresia of the left coronary ostium and the left main coronary artery, often associated with death at an early age, may also be compatible with symptom-free longevity. Moreover, attention is focused on the nomenclature of single coronary anomalies.