The coronary arteries of the heart begin. Main types of blood supply to the myocardium

The main source of blood supply to the heart is coronary arteries(Fig. 1.22).

The left and right coronary arteries branch from the initial part of the ascending aorta in the left and right sinuses. The location of each coronary artery varies both in height and circumference of the aorta. The orifice of the left coronary artery can be located at the level of the free edge of the semilunar valve (42.6% of cases), above or below its edge (in 28 and 29.4%, respectively).

For the mouth of the right coronary artery, the most common location is above the free edge of the semilunar valve (51.3% of observations), at the level of the free edge (30%) or below it (18.7%). The upward displacement of the orifices of the coronary arteries from the free edge of the semilunar valve is up to 10 mm for the left and 13 mm for the right coronary artery, downward - up to 10 mm for the left and 7 mm for the right coronary artery.

In isolated observations, more significant vertical displacements of the mouths of the coronary arteries are noted, right up to the beginning of the aortic arch.

Rice. 1.22. Blood supply system of the heart: 1 - ascending aorta; 2 - superior vena cava; 3 - right coronary artery; 4 - aircraft; 5 - left coronary artery; 6 - great vein of the heart

In relation to the midline of the sinus, the mouth of the left coronary artery in 36% of cases is shifted to the anterior or posterior edge. A significant displacement of the beginning of the coronary arteries along the circumference of the aorta leads to the departure of one or both coronary arteries from the aortic sinuses, which are unusual for them, and in in rare cases both coronary arteries arise from the same sinus. Changing the location of the mouths of the coronary arteries along the height and circumference of the aorta does not affect the blood supply to the heart.

The left coronary artery is located between the beginning pulmonary trunk and the left ear of the heart and is divided into the circumflex and anterior interventricular branches.

The latter follows to the apex of the heart, located in the anterior interventricular groove. The circumflex branch is directed under the left ear in the coronary sulcus to the diaphragmatic (posterior) surface of the heart. The right coronary artery, after leaving the aorta, lies under the right auricle between the beginning of the pulmonary trunk and the right atrium. Then it turns along the coronary groove to the right, then back, reaching the posterior longitudinal groove, along which it descends to the apex of the heart, now called the posterior interventricular branch. The coronary arteries and their large branches lie on the surface of the myocardium, located on different depths in the subepicardial tissue.

The branches of the main trunks of the coronary arteries are divided into three types - main, diffuse and transitional. Trunk type branching of the left coronary artery is observed in 50% of cases, scattered - in 36% and transitional - in 14%. The latter is characterized by the division of its main trunk into 2 permanent branches - the circumflex and the anterior interventricular. TO loose type These include cases when the main trunk of the artery gives off interventricular, diagonal, accessory diagonal and circumflex branches at the same or almost the same level. From the front interventricular branch, as well as from the envelope, 4–15 branches depart. The angles of origin of both primary and subsequent vessels are different and range from 35–140°.

According to the International Anatomical Nomenclature, adopted at the Congress of Anatomists in Rome in 2000, there are following vessels, supplying blood to the heart:

Left coronary artery (arteria coronaria sinistra)

Anterior interventricular branch (r. interventricularis anterior)
Diagonal branch (r. diagonalis)
Branch of the conus arteriosus (r. coni arteriosi)
Lateral branch (r. lateralis)
Septal interventricular branches (rr. interventricularis septales)
Circumflex branch (r. circumfl exus)
Anastomotic atrial branch (r. atri alis anastomicus)
Atrioventricular branches (rr. atrioventricularis)
Left marginal branch (r. marginalis sinister)
Intermediate atrial branch (r. Atrialis intermedius).
Posterior branch of the left ventricle (r. posterior ventriculi sinistri)
Branch of the atrioventricular node (r. nodi atrioventricularis)

Right coronary artery (arteria coronaria dextra)

Branch of the conus arteriosus (ramus coni arteriosi)
Branch of the sinoatrial node (r. Nodi sinoatrialis)
Atrial branches (rr. atriales)
Right marginal branch (r. marginalis dexter)
Intermediate atrial branch (r. atrialis intermedius)
Posterior interventricular branch (r. interventricularis posterior)
Septal interventricular branches (rr. interventriculares septales)
Branch of the atrioventricular node (r. nodi atrioventricularis).

By 15–18 years, the diameter of the coronary arteries (Table 1.1) approaches those of adults. At the age of over 75 years, there is a slight increase in the diameter of these arteries, which is associated with the loss of the elastic properties of the arterial wall. In most people, the diameter of the left coronary artery is larger than the right. The number of arteries branching from the aorta to the heart can decrease to 1 or increase to 4 due to additional coronary arteries, which are not normally present.

The left coronary artery (LCA) originates in the posterointernal sinus of the aortic bulb, passes between the left atrium and the PA and after approximately 10–20 mm divides into the anterior interventricular and circumflex branches.

The anterior interventricular branch is a direct continuation of the LCA and runs in the corresponding groove of the heart. The anterior interventricular branch of the LCA departs from diagonal branches(from 1 to 4), which participate in the blood supply to the lateral wall of the LV and can anastomose with the circumflex branch of the LV. The LCA gives off 6 to 10 septal branches, which supply the anterior two-thirds of the interventricular septum. The anterior interventricular branch of the LCA itself reaches the apex of the heart, supplying it with blood.

Sometimes the anterior interventricular branch passes to the diaphragmatic surface of the heart, anastomosing with the posterior interventricular artery of the heart, carrying out collateral blood flow between the left and right coronary arteries (with right or balanced types of blood supply to the heart).

Table 1.1

The right marginal branch was previously called the artery of the acute edge of the heart - ramus margo acutus cordis. The left marginal branch is the branch of the obtuse edge of the heart - ramus margo obtusus cordis, since the well-developed myocardium of the LV of the heart makes its edge rounded and blunt).

Thus, the anterior interventricular branch of the LCA supplies the anterolateral wall of the LV, its apex, most of the interventricular septum, as well as the anterior papillary muscle (due to the diagonal artery).

The circumflex branch, departing from the LCA, located in the AV (coronary) groove, bends around the heart on the left, reaching the intersection and the posterior interventricular groove. The circumflex branch can either end at the obtuse edge of the heart or continue in the posterior interventricular groove. Passing in the coronary sulcus, the circumflex branch sends large branches to the lateral and posterior walls of the LV. In addition, important atrial arteries depart from the circumflex branch (including r. nodi sinoatrialis). These arteries, especially the sinus node artery, anastomose abundantly with branches of the right coronary artery (RCA). Therefore, the branch of the sinus node is of “strategic” importance in the development of atherosclerosis in one of the main arteries.

The RCA begins in the anterior internal sinus of the aortic bulb. Departing from the anterior surface of the aorta, the RCA is located on the right side of the coronary sulcus, approaches the sharp edge of the heart, goes around it and goes to the crux and then to the posterior interventricular sulcus. At the intersection of the posterior interventricular and coronary grooves (crux), the RCA gives off the posterior interventricular branch, which goes towards the distal part of the anterior interventricular branch, anastomosing with it. Rarely, the RCA ends at the acute edge of the heart.

The RCA supplies blood with its branches right atrium, part of the anterior and entire posterior surface of the LV, the interatrial septum and the posterior third of the interventricular septum. Important branches of the RCA include the branch of the conus pulmonary trunk, the branch of the sinus node, the branch of the right edge of the heart, and the posterior interventricular branch.

The branch of the conus pulmonary trunk often anastomoses with the conus branch, which arises from the anterior interventricular branch, forming the ring of Viessen. However, in approximately half of the cases (Schlesinger M. et al., 1949), the conus pulmonary artery departs from the aorta independently.

The branch of the sinus node in 60–86% of cases (Arev M.Ya., 1949) arises from the RCA, but there is evidence that in 45% of cases (James T., 1961) it can arise from the circumflex branch of the LMCA and even from the LMCA itself . The branch of the sinus node is located along the wall of the RV and reaches the point where the superior vena cava flows into the right atrium.

At the sharp edge of the heart, the RCA gives off a fairly constant branch - the branch of the right edge, which runs along the sharp edge to the apex of the heart. At approximately this level, a branch arises to the right atrium, which supplies blood to the anterior and lateral surfaces of the right atrium.

At the junction of the RCA and the posterior interventricular artery, a branch of the AV node departs from it, which supplies blood to this node. From the posterior interventricular branch, branches extend perpendicularly to the RV, as well as short branches to the posterior third of the interventricular septum, which anastomose with similar branches extending from the anterior interventricular artery of the LCA.

Thus, the RCA supplies blood to the anterior and posterior walls of the RV, partially to the posterior wall of the LV, the right atrium, upper half interatrial septum, sinus and AV nodes, as well as back interventricular septum and posterior papillary muscle.

V.V. Bratus, A.S. Gavrish "Structure and functions of the cardiovascular system"

Arteries of the heart move away from aortic bulbs,bulbils aortae, - the initial expanded section of the ascending aorta and, like a crown, surround the heart, and therefore are called the coronary arteries. The right coronary artery begins at the level of the right aortic sinus, and the left coronary artery begins at the level of its left sinus. Both arteries depart from the aorta below the free (upper) edges of the semilunar valves, therefore, during contraction (systole) of the ventricles, the valves cover the openings of the arteries and almost do not allow blood to pass to the heart. When the ventricles relax (diastole), the sinuses fill with blood, closing its path from the aorta back to the left ventricle, and at the same time opening the access of blood to the vessels of the heart.

Right coronary artery,a. corondria dextra, goes to the right under the appendage of the right atrium, lies in the coronary groove, goes around the right pulmonary surface of the heart, then follows along its posterior surface to the left, where its end anastomoses with the circumflex branch of the left coronary artery. Most large branch the right coronary artery is posterior interventricular branch, d.interventrlculdris posterior, which is directed along the groove of the heart of the same name towards its apex. The branches of the right coronary artery supply blood to the wall of the right ventricle and atrium, the posterior part of the interventricular septum, the papillary muscles of the right ventricle, the posterior papillary muscle of the left ventricle, the sinoatrial and atrioventricular nodes of the conduction system of the heart.

Left coronary artery,a. corondria sinistra, slightly thicker than the right one. Located between the beginning of the pulmonary trunk and the left atrial appendage, it is divided into two branches: anterior interventricular branch, d.interventriculdrls anterior, And circumflex branch, g.circumflexus. The latter, which is a continuation of the main trunk of the coronary artery, bends around the heart on the left, located in its coronary sulcus, where on the posterior surface of the organ it anastomoses with the right coronary artery. The anterior interventricular branch follows the same groove of the heart towards its apex. In the area of the cardiac notch, it sometimes passes to the diaphragmatic surface of the heart, where it anastomoses with the terminal portion of the posterior interventricular branch of the right coronary artery. Branches of the left coronary artery supply the wall of the left ventricle, including the papillary muscles, most of the interventricular septum, the anterior wall of the right ventricle, and the wall of the left atrium.

The branches of the right and left coronary arteries, connecting, form two arterial rings in the heart: a transverse one, located in the coronary groove, and a longitudinal one, the vessels of which are located in the anterior and posterior interventricular grooves.

The branches of the coronary arteries provide blood supply to all layers of the walls of the heart. In the myocardium, where the level of oxidative processes is highest, microvessels anastomosing among themselves repeat the course of the muscle fiber bundles of its layers.

There are different options for the distribution of branches of the coronary arteries, which are called types of blood supply to the heart. The main ones are the following: right coronary, when most parts of the heart are supplied with blood by the branches of the right coronary artery; left coronary, when most of the heart receives blood from the branches of the left coronary artery, and middle, or uniform, in which both coronary arteries evenly participate in the blood supply to the walls of the heart. There are also transitional types of blood supply to the heart - middle-right and middle-left. It is generally accepted that among all types of blood supply to the heart, the middle-right type is predominant.

Variations and anomalies in the position and branching of the coronary arteries are possible. They manifest themselves in changes in the origin and number of coronary arteries. Thus, the latter can extend from the aopfbi directly above the semilunar valves or significantly higher - from the left subclavian artery, and not from the aorta. The coronary artery may be the only one, that is, unpaired, there may be 3-4 coronary arteries, and not two: two arteries depart to the right and left of the aorta, or two from the aorta and two from the left subclavian artery.

Along with the coronary arteries, non-permanent (accessory) arteries go to the heart (especially to the pericardium). These can be the mediastinal-pericardial branches (upper, middle and lower) of the internal thoracic artery, branches of the pericardial-phragmatic artery, branches extending from the concave surface of the glacial aorta, etc.

Veins of the heart more numerous than arteries. Most of the large veins of the heart are collected into one common wide venous vessel - coronary sinus,sinus corondrius (remnant of the embryonic left common cardinal vein). The sinus is located in the coronary groove on the posterior surface of the heart and opens into the right atrium below and anterior to the opening of the inferior vena cava (between its valve and the interatrial septum). The tributaries of the coronary sinus are 5 veins: 1) great vein of the heart,v. cordis [ cardldca] magna, which begins at the apex of the heart on its anterior surface, lies in the anterior interventricular groove next to the anterior interventricular branch of the left coronary artery, then at the level of the coronary groove turns to the left, passes under the circumflex branch of the left coronary artery, lies in the coronary groove on the posterior surface of the heart, where it continues into the coronary sinus. The vein collects blood from the veins of the anterior surface of both ventricles and the interventricular septum. The veins of the posterior surface of the left atrium and left ventricle also flow into the great vein of the heart; 2) middle vein of the heart,v. cordis [ cardidca] media, is formed in the region of the posterior surface of the apex of the heart, rises up the posterior interventricular groove (adjacent to the posterior interventricular branch of the right coronary artery) and flows into the coronary sinus; 3) small vein of the heart,v. cordis [ cardidca] pdrva, begins on the right pulmonary surface of the right ventricle, rises upward, lies in the coronary groove on the diaphragmatic surface of the heart and flows into the coronary sinus; it collects blood mainly from the right half of the heart; 4) posterior vein of the left ventricle,And.posterior ventriculi sinistri [ v. ventriculi sinistri posterior], formed from several veins on the posterior surface of the left ventricle, closer to the apex of the heart, and flows into the coronary sinus or great vein of the heart; 5) oblique vein of the left atrium,v. obliqua dtrii sinistri, follows from top to bottom along the posterior surface of the left atrium and flows into the coronary sinus.

In addition to the veins that flow into the coronary sinus, the heart has veins that open directly into the right atrium. This anterior veins of the heart,uv. cordis [ cardidcae] anteriorcs, collecting blood from the anterior wall of the right ventricle. They head up to the base of the heart and open into the right atrium. Smallest veins of the heart(tebesian veins), vv. cordis [ cardidcae] minimae, only 20-30, begin in the thickness of the walls of the heart and flow directly into the right atrium and partially into the ventricles and left atrium through openings of the smallest veins,foramina vendrum minimdrum.

Lymphatic bed The walls of the heart consist of lymphatic capillaries located in the form of networks in the endocardium, myocardium and epicardium. Lymph from the endocardium and myocardium flows into the superficial network of lymphatic capillaries and the plexus of lymphatic vessels located in the epicardium. Connecting with each other, lymphatic vessels enlarge and form the two main vessels of the heart, through which lymph flows to the regional lymph nodes. Left lymphatic vessel The heart is formed from the fusion of the lymphatic vessels of the anterior surfaces of the right and left ventricles, the left pulmonary and posterior surfaces of the left ventricle. It follows from the left ventricle to the right, passes behind the pulmonary trunk and flows into one of the lower tracheobronchial lymph nodes. Right lymphatic vessel The heart is formed from the lymphatic vessels of the anterior and posterior surfaces of the right ventricle, is directed from right to left along the anterior semicircle of the pulmonary trunk and flows into one of the anterior mediastinal lymph nodes located at the ligament arteriosus. Small lymphatic vessels through which lymph flows from the walls of the atria flow into the nearby anterior mediastinal lymph nodes.

Blood, thanks to the “internal motor” - the heart, circulates throughout the body, saturating every cell with nutrients and oxygen. How does the heart itself receive nutrition? Where does it get its reserves and strength for work? And do you know about the so-called third circle of blood circulation or heart? To better understand the anatomy of the vessels supplying the heart, let's look at the main anatomical structures that are usually identified in the central organ of cardio-vascular system.

1 External structure of the human “motor”

First-year students of medical colleges and medical universities learn by heart, and even in Latin, that the heart has an apex, a base, and two surfaces: the anterior superior and inferior, separated by edges. Naked eye you can see the cardiac grooves by looking at its surface. There are three of them:

coronal sulcus,
Anterior interventricular
Posterior interventricular.

The atria are visually separated from the ventricles by the coronary groove, and the border between the two lower chambers along the anterior surface is approximately the anterior interventricular groove, and along the rear surface the interventricular posterior groove. The interventricular grooves join at the apex slightly to the right. These grooves were formed due to the vessels running in them. In the coronary groove, which separates the cardiac chambers, there is the right coronary artery, the sinus veins, and in the anterior interventricular groove, which separates the ventricles, there is a large vein and an anterior interventricular branch.

The posterior interventricular groove is the receptacle for the interventricular branch of the right coronary artery, the middle cardiac vein. From the abundance of numerous medical terminology your head can go spinning: furrows, arteries, veins, branches... Of course, because we are analyzing the structure and blood supply of the most important human organ- hearts. If it were simpler, would it be able to perform such complex and responsible work? Therefore, let’s not give up halfway, and analyze in detail the anatomy of the heart vessels.

2 3rd or cardiac circle of blood circulation

Every adult knows that there are 2 circles of blood circulation in the body: large and small. But anatomists say that there are three of them! So is the basic anatomy course misleading? Not at all! The third circle, named figuratively, refers to the vessels that fill the blood and “serve” the heart itself. It deserves personal vessels, doesn't it? So, the 3rd or cardiac circle begins with the coronary arteries, which are formed from the main vessel human body- Her Majesty's aorta, and ends with the cardiac veins, merging into the coronary sinus.

It in turn opens in . And the smallest venules open into the atrial cavity on their own. It was noticed very figuratively that the vessels of the heart entwine and envelop it like a real crown, a crown. Therefore, arteries and veins are called coronary or coronary. Remember: these are synonymous terms. So what are the most important arteries and veins the heart has at its disposal? What is the classification of coronary arteries?

3 Main arteries

The right coronary artery and the left coronary artery are two whales that deliver oxygen and nutrients. They have branches and offshoots, which we will discuss later. For now, let’s understand that the right coronary artery is responsible for filling the right heart chambers, the walls of the right ventricle and the posterior wall of the left ventricle, and the left coronary artery supplies blood to the left heart chambers.

The right coronary artery goes around the heart along the coronary sulcus on the right, giving off the posterior interventricular branch (posterior descending artery), which descends to the apex, located in the posterior interventricular groove. The left coronary also lies in the coronary sulcus, but on the other, opposite side - in front of the left atrium. It is divided into two important branches - the anterior interventricular (anterior descending artery) and the circumflex artery.

The path of the anterior interventricular branch runs in the recess of the same name, to the apex of the heart, where our branch meets and merges with the branch of the right coronary artery. And the left circumflex artery continues to “hug” the heart on the left along the coronary sulcus, where it also unites with the right coronary. Thus, nature created an arterial ring of coronary vessels on the surface of the human “motor” in a horizontal plane.

This is an adaptive element, in case a vascular catastrophe suddenly occurs in the body and blood circulation sharply deteriorates, then despite this the heart will be able to maintain blood supply and its work for some time, or if one of the branches is blocked by a blood clot, the blood flow will not stop, but will continue differently heart vessel. The ring is collateral circulation organ.

The branches and their smallest branches penetrate the entire thickness of the heart, supplying blood not only to the upper layers, but to the entire myocardium and the inner lining of the chambers. Intramuscular arteries follow the course of the muscular cardiac bundles; each cardiomyocyte is saturated with oxygen and nutrition due to a well-developed system of anastomoses and arterial blood supply.

It should be noted that in a small percentage of cases (3.2-4%), people have such anatomical feature as a third or accessory coronary artery.

4 Forms of blood supply

There are several types of blood supply to the heart. All of them are a variant of the norm and a consequence individual characteristics laying of the heart vessels and their functioning in each person. Depending on the prevailing distribution of one of the coronary arteries on the posterior heart wall, they are distinguished:

Legal type. With this type of blood supply to the heart, the left ventricle (posterior surface of the heart) is filled with blood primarily from the right coronary artery. This type of blood supply to the heart is the most common (70%)
Left-handed type. Occurs if the left coronary artery predominates in the blood supply (in 10% of cases).
Uniform type. With approximately equal “contribution” to the blood supply of both vessels. (20%).

5 Major veins

Arteries branch into arterioles and capillaries, which, having completed cellular exchange and taking decay products and carbon dioxide, are organized into venules, and then more large veins. Venous blood can flow into venous sinus(from it the blood then enters the right atrium), or into the atrial cavity. The most significant cardiac veins that drain blood into the sinus are:

Big. Picks up venous blood from the anterior surface of the two lower chambers, lies in the interventricular anterior groove. The vein begins at the apex.
Average. It also originates at the apex, but runs along the posterior groove.
Small. It can flow into the middle one and is located in the coronal sulcus.

The veins that drain directly into the atria are the anterior and smallest cardiac veins. The smallest veins are not named so by chance, because the diameter of their trunks is very small; these veins do not appear on the surface, but lie in the heart deep tissues and open mainly into the upper chambers, but can also pour into the ventricles. The anterior cardiac veins supply blood to the right upper chamber. In this way, you can imagine in the most simplified way how the blood supply to the heart occurs and the anatomy of the coronary vessels.

Once again I would like to emphasize that the heart has its own, personal, coronary circle of blood circulation, thanks to which separate blood circulation can be maintained. The most important cardiac arteries are the right and left coronary, and the veins are large, middle, small, and anterior.

6 Diagnostics of coronary vessels

Coronary angiography is the “gold standard” in diagnosing coronary arteries. This is the most exact method, it is produced in specialized hospitals by highly qualified medical workers, the procedure is performed according to indications, under local anesthesia. The doctor inserts a catheter through the artery of the arm or thigh, and through it a special radiopaque agent, which, mixing with blood, spreads, making both the vessels themselves and their lumen visible.

Pictures and video recordings of the filling of the vessels with the substance are taken. The results allow the doctor to make a conclusion about the patency of the vessels, the presence of pathology in them, assess the prospects for treatment and the possibility of recovery. Also to diagnostic methods studies of coronary vessels include MSCT - angiography, ultrasonography with Doppler, electron beam tomography.

The arteries of the heart depart from the aortic bulb - the initial expanded section of the ascending aorta and, like a crown, surround the heart, and therefore are called coronary arteries. The right coronary artery begins at the level of the right aortic sinus, and the left coronary artery begins at the level of its left sinus. Both arteries depart from the aorta below the free (upper) edges of the semilunar valves, therefore, during contraction (systole) of the ventricles, the valves cover the openings of the arteries and almost do not allow blood to pass to the heart. When the ventricles relax (diastole), the sinuses fill with blood, closing its path from the aorta back to the left ventricle, and at the same time opening the access of blood to the vessels of the heart.

Right coronary artery

It goes to the right under the appendage of the right atrium, lies in the coronary groove, goes around the right pulmonary surface of the heart, then follows its posterior surface to the left, where its end anastomoses with the circumflex branch of the left coronary artery. The largest branch of the right coronary artery is the posterior interventricular branch, which is directed along the same groove of the heart towards its apex. The branches of the right coronary artery supply blood to the wall of the right ventricle and atrium, the posterior part of the interventricular septum, the papillary muscles of the right ventricle, the posterior papillary muscle of the left ventricle, the sinoatrial and atrioventricular nodes of the conduction system of the heart.

Left coronary artery

Slightly thicker than the right one. Located between the beginning of the pulmonary trunk and the left atrial appendage, it is divided into two branches: the anterior interventricular branch and the circumflex branch. The latter, which is a continuation of the main trunk of the coronary artery, bends around the heart on the left, located in its coronary sulcus, where on the posterior surface of the organ it anastomoses with the right coronary artery. The anterior interventricular branch follows the same groove of the heart towards its apex. In the area of the cardiac notch, it sometimes passes to the diaphragmatic surface of the heart, where it anastomoses with the terminal section of the posterior interventricular branch of the right coronary artery. Branches of the left coronary artery supply the wall of the left ventricle, including the papillary muscles, most of the interventricular septum, the anterior wall of the right ventricle, and the wall of the left atrium.

Variations and anomalies in the position and branching of the coronary arteries are possible. They manifest themselves in changes in the origin and number of coronary arteries. Thus, the latter can arise from the aorta directly above the semilunar valves or much higher - from the left subclavian artery, and not from the aorta. The coronary artery may be the only one, that is, unpaired, there may be 3 - 4 coronary arteries, and not two: two arteries depart to the right and left of the aorta, or two from the aorta and two from the left subclavian artery.

Along with the coronary arteries, non-permanent (accessory) arteries go to the heart (especially to the pericardium). These may be the mediastinal-pericardial branches (upper, middle and lower) of the internal thoracic artery, branches of the pericardial-phragmatic artery, branches extending from the concave surface of the aortic arches, etc.

Coronary arteries- these are the two main channels through which blood flows to the heart and its elements.

Another common name for these vessels is coronoid. They surround the contractile muscle from the outside, supplying its structures with oxygen and necessary substances.

Two coronary arteries go to the heart. Let's take a closer look at their anatomy. Right nourishes the ventricle and atrium located on its side, and also carries blood to part of the posterior wall of the left ventricle. It departs from the anterior sinus of Vilsava and is located in the thickness of the adipose tissue on the right of the pulmonary artery. Next, the vessel bends around the myocardium along the atrioventricular groove and continues to the posterior wall of the organ to the longitudinal one. The right coronary artery also reaches the apex of the heart. Along its entire length, it gives one branch to the right ventricle, namely to its anterior, posterior wall and papillary muscles. This vessel also has branches extending to the sinoaricular node and interventricular septum.

The supply of blood to the left and partially to the right ventricle is provided by the second coronary artery. It arises from the posterior left sinus of Valsava and, heading towards the longitudinal anterior sulcus, is located between pulmonary artery and left atrium. Then it reaches the apex of the heart, bends over it and continues along the posterior surface of the organ.

This vessel is quite wide, but at the same time short. Its length is about 10 mm. Departing diagonal branches supply blood to the anterior and side surfaces left ventricle. There are also several small branches that extend from the vessel at an acute angle. Some of them are septal, located on the anterior surface of the left ventricle, perforating the myocardium and forming vasculature on almost the entire interventricular septum. The superior of the septal branches extends to the right ventricle, the anterior wall and to its papillary muscle.

The left coronary artery gives off 3 or 4 large branches that have important. The main one is considered anterior descending artery, which is a continuation of the left coronary. Responsible for feeding the anterior wall of the left ventricle and part of the right, as well as the apex of the myocardium. The anterior descending branch extends along the heart muscle and in places plunges into it, and then passes through the fatty tissue of the epicardium.

The second important branch is circumflex artery, which is responsible for feeding the posterior surface of the left ventricle, and the branch that separates from it carries blood to its lateral parts. This vessel departs from the left coronary artery at its very beginning at an angle, runs in a transverse groove in the direction of the obtuse edge of the heart and, bending around it, stretches along the posterior wall of the left ventricle. Then it goes downward posterior artery and continues to the top. The circumflex artery has several significant branches, carrying blood to the papillary muscles, as well as the walls of the left ventricle. One of the branches also supplies the sinoaricular node.

The anatomy of the coronary arteries is quite complex. The orifices of the right and left vessels extend directly from the aorta, located behind its valve. All cardiac veins connect to coronary sinus, opening on the posterior surface of the right atrium.

Arterial pathologies

Due to the fact that coronary vessels provide blood supply to the main organ human body, then their defeat leads to the development coronary disease, as well as myocardial infarction.

The reasons for the deterioration of blood flow through these vessels are atherosclerotic plaques and blood clots that form in the lumen and narrow it, and sometimes cause partial or complete blockage.

The left ventricle of the heart performs the main pumping function, therefore poor blood supply to it often leads to serious complications, disability and even fatal outcome. If one of the coronary arteries supplying it is blocked, it is necessary to mandatory carry out stenting or bypass surgery aimed at restoring blood flow. Depending on which vessel supplies the left ventricle, the following types of blood supply are distinguished:

Right. In this position, the posterior surface of the left ventricle receives blood from the right coronary artery.
Left. With this type of blood supply, the main role is played by the left coronary artery.
Balanced. Back wall The left ventricle is equally supplied by both coronary arteries.

After establishing the type of blood supply, the doctor can determine which of the coronary arteries or its branches is blocked and needs surgical correction.

In order to prevent the development of stenosis and occlusion of the vessels supplying blood to the heart, it is necessary to regularly undergo diagnostics and promptly treat a disease such as atherosclerosis.