Orifices of the coronary arteries in Latin. See what "Coronary arteries" are in other dictionaries

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Widespread use of selective coronary angiography and surgical interventions on the coronary arteries of the heart in last years made it possible to study anatomical features coronary circulation living person, to develop a functional anatomy of the arteries of the heart in relation to revascularization operations in patients with coronary heart disease.

Interventions on the coronary arteries for diagnostic and therapeutic purposes place increased demands on the study of vessels on different levels taking into account their variants, developmental anomalies, caliber, angles of departure, possible collateral connections, as well as their projections and relationships with surrounding formations.

When organizing this data, we Special attention referred to information from surgical anatomy coronary arteries, based on the principle of topographic anatomy in relation to the operation plan with the division of the coronary arteries of the heart into segments.

The right and left coronary arteries were conditionally divided into three and seven segments, respectively (Fig. 51).

Three segments were distinguished in the right coronary artery: I - a segment of the artery from the mouth to the outlet of the branch - the artery of the sharp edge of the heart (length from 2 to 3.5 cm); II - section of the artery from the branch of the sharp edge of the heart to the discharge of the posterior interventricular branch of the right coronary artery (length 2.2-3.8 cm); III - posterior interventricular branch of the right coronary artery.

The initial section of the left coronary artery from the mouth to the place of division into the main branches is designated as segment I (length from 0.7 to 1.8 cm). The first 4 cm of the anterior interventricular branch of the left coronary artery is divided

Rice. 51. Segmental division of the coronary

heart arteries:

A- right coronary artery; B- left coronary artery

into two segments of 2 cm each - II and III segments. The distal portion of the anterior interventricular branch was segment IV. The circumflex branch of the left coronary artery to the point of origin of the branch of the blunt edge of the heart is the V segment (length 1.8-2.6 cm). The distal section of the circumflex branch of the left coronary artery was more often represented by the artery of the obtuse margin of the heart - segment VI. And finally, the diagonal branch of the left coronary artery is the VII segment.

The use of segmental division of the coronary arteries, as our experience has shown, is advisable in a comparative study of the surgical anatomy of the coronary circulation according to selective coronary angiography and surgical interventions, to determine the localization and distribution pathological process in the arteries of the heart practical value when choosing a method of surgical intervention in case of coronary heart disease.

Rice. 52. Right-wing type of coronary circulation. Well developed posterior interventricular branches

Beginning of the coronary arteries . Sinuses of the aorta, from which the coronary arteries depart, James (1961) proposes to call the right and left coronary sinus. The orifices of the coronary arteries are located in the bulb of the ascending aorta at the level of the free edges of the aortic semilunar valves or 2-3 cm above or below them (V. V. Kovanov and T. I. Anikina, 1974).

The topography of the sections of the coronary arteries, as A. S. Zolotukhin (1974) points out, is different and depends on the structure of the heart and chest. According to M. A. Tikhomirov (1899), the orifices of the coronary arteries in the aortic sinuses can be located below the free edge of the valves "abnormally low", so that the semilunar valves pressed against the wall of the aorta close the orifices, either at the level of the free edge of the valves, or above them, by wall of the ascending aorta.

The level of the location of the mouths is of practical importance. With a high location at the time of left ventricular systole, the orifice is

under the blow of a stream of blood, not being covered by the edge of the semilunar valve. According to A. V. Smolyannikov and T. A. Naddachina (1964), this may be one of the reasons for the development of coronary sclerosis.

The right coronary artery in most patients has a main type of division and plays important role in the vascularization of the heart, especially its posterior diaphragmatic surface. In 25% of patients in the blood supply to the myocardium, we revealed the predominance of the right coronary artery (Fig. 52). N. A. Javakhshivili and M. G. Komakhidze (1963) describe the beginning of the right coronary artery in the region of the anterior right sinus of the aorta, indicating that its high discharge is rarely observed. The artery enters the coronary sulcus, located behind the base of the pulmonary artery and under the auricle of the right atrium. The section of the artery from the aorta to the sharp edge of the heart (segment I of the artery) is adjacent to the wall of the heart and is completely covered by subepicardial fat. The diameter of segment I of the right coronary artery ranges from 2.1 to 7 mm. Along the artery trunk on the anterior surface of the heart in the coronal groove, epicardial folds are formed, filled with adipose tissue. Abundantly developed adipose tissue is noted along the artery from the sharp edge of the heart. The atherosclerotically altered trunk of the artery along this length is well palpated in the form of a cord. Detection and isolation of segment I of the right coronary artery on the anterior surface of the heart is usually not difficult.

The first branch of the right coronary artery - the artery of the arterial cone, or the fatty artery - leaves directly at the beginning of the coronary sulcus, continuing down to the right at the arterial cone, giving branches to the cone and the wall of the pulmonary trunk. In 25.6% of patients, we observed its common beginning with the right coronary artery, its mouth was located at the mouth of the right coronary artery. In 18.9% of patients, the mouth of the conus artery was located next to the mouth of the coronary artery, located behind the latter. In these cases, the vessel originated directly from the ascending aorta and was only slightly inferior in size to the trunk of the right coronary artery.

Muscular branches depart from the I segment of the right coronary artery to the right ventricle of the heart. Vessels in the amount of 2-3 are located closer to the epicardium in connective tissue couplings on the layer of adipose tissue covering the epicardium.

The other most significant and permanent branch of the right coronary artery is the right marginal artery (a branch of the sharp edge of the heart). The artery of the acute edge of the heart, a constant branch of the right coronary artery, departs in the region of the acute edge of the heart and descends along the lateral surface of the heart to its apex. It supplies blood to the anterior-lateral wall of the right ventricle, and sometimes to the diaphragmatic part of it. In some patients, the diameter of the lumen of the artery was about 3 mm, but more often it was 1 mm or less.

Continuing along the coronary sulcus, the right coronary artery goes around the sharp edge of the heart, passes to the posterior diaphragmatic surface of the heart and ends to the left of the posterior interventricular sulcus, not reaching the blunt edge of the heart (in 64% of patients).

The final branch of the right coronary artery - the posterior interventricular branch (III segment) - is located in the posterior interventricular groove, descending along it to the apex of the heart. V. V. Kovanov and T. I. Anikina (1974) distinguish three variants of its distribution: 1) in the upper part of the furrow of the same name; 2) throughout this groove to the top of the heart; 3) the posterior interventricular branch enters the anterior surface of the heart. According to our data, only in 14% of patients it reached

apex of the heart, anastomosing with the anterior interventricular branch of the left coronary artery.

From the posterior interventricular branch into the interventricular septum at right angles, from 4 to 6 branches depart, supplying blood to the conducting system of the heart.

With a right-sided type of coronary blood supply to the diaphragmatic surface of the heart, 2-3 muscle branches extend from the right coronary artery, running parallel to the posterior interventricular branch of the right coronary artery.

To access the II and III segments of the right coronary artery, it is necessary to lift the heart up and take it to the left. II segment of the artery is located superficially in the coronary sulcus; it can be easily and quickly found and selected. The posterior interventricular branch (III segment) is located deep in the interventricular groove and is covered by subepicardial fat. When performing operations on the II segment of the right coronary artery, it must be remembered that the wall of the right ventricle in this place is very thin. Therefore, it should be handled carefully to avoid perforation.

The left coronary artery, participating in the blood supply to most of the left ventricle, interventricular septum, as well as the anterior surface of the right ventricle, dominates the blood supply to the heart in 20.8% of patients. Starting in the left sinus of Valsalva, it goes from the ascending aorta to the left and down the coronary sulcus of the heart. The initial section of the left coronary artery (I segment) before the bifurcation has a length of at least 8 mm and not more than 18 mm. Isolation of the main trunk of the left coronary artery is difficult, since it is hidden by the root of the pulmonary artery.

The short trunk of the left coronary artery, 3.5 to 7.5 mm in diameter, turns to the left between the pulmonary artery and the base of the left auricle of the heart and divides into the anterior interventricular and circumflex branches. (II, III, IV segments of the left coronary artery) is located in the anterior interventricular groove of the heart, along which it goes to the apex of the heart. It can end at the apex of the heart, but usually (according to our observations, in 80% of patients) it continues on the diaphragmatic surface of the heart, where it meets the terminal branches of the posterior interventricular branch of the right coronary artery and participates in the vascularization of the diaphragmatic surface of the heart. The diameter of segment II of the artery ranges from 2 to 4.5 mm.

It should be noted that a significant part of the anterior interventricular branch (segments II and III) lies deep, covered by subepicardial fat and muscle bridges. The isolation of the artery in this place requires great care because of the danger of possible damage to its muscular and, most importantly, septal branches leading to the interventricular septum. The distal part of the artery (IV segment) is usually located superficially, clearly visible under thin layer subepi-cardiac tissue and is easily allocated.

From the II segment of the left coronary artery, from 2 to 4 septal branches extend deep into the myocardium, which are involved in the vascularization of the interventricular septum of the heart.

Throughout the anterior interventricular branch of the left coronary artery, 4-8 muscle branches depart to the myocardium of the left and right ventricles. The branches to the right ventricle are smaller in caliber than to the left, although they are the same in size as the muscular branches from the right coronary artery. A significantly larger number of branches extend to the anterior-lateral wall of the left ventricle. Functionally, it is especially important diagonal branches(there are 2 of them, sometimes - 3), extending from the II and III segments of the left coronary artery.

When searching for and isolating the anterior interventricular branch, an important landmark is the large vein of the heart, which is located in the anterior interventricular groove to the right of the artery and is easily found under a thin layer of the epicardium.

The circumflex branch of the left coronary artery (V-VI segments) departs at a right angle to the main trunk of the left coronary artery, located in the left coronary sulcus, under the left ear of the heart. Its permanent branch - the branch of the blunt edge of the heart - descends over a considerable distance at the left edge of the heart, somewhat backwards, and in 47.2% of patients reaches the apex of the heart.

After the branches branch off to the blunt edge of the heart and the posterior surface of the left ventricle, the circumflex branch of the left coronary artery in 20% of patients continues along the coronary sulcus or along the posterior wall of the left atrium in the form of a thin trunk and reaches the confluence of the inferior posterior vein.

The V segment of the artery is easily detected, which is located in the fatty membrane under the ear of the left atrium and is covered by a large vein of the heart. The latter sometimes has to be crossed to gain access to the trunk of the artery.

The distal envelope of the branch (VI segment) is usually located on the posterior surface of the heart and, if necessary, surgical intervention on it, the heart is lifted and taken to the left while pulling the left ear of the heart.

The diagonal branch of the left coronary artery (VII segment) goes along the anterior surface of the left ventricle down and to the right, then plunging into the myocardium. The diameter of its initial part is from 1 to 3 mm. With a diameter of less than 1 mm, the vessel is little expressed and is more often considered as one of the muscular branches of the anterior interventricular branch of the left coronary artery.

Anatomy of the coronary arteries

coronary arteries

From an anatomical point of view, the coronary artery system is divided into two parts - right and left. From a surgical standpoint, the coronary artery is divided into four parts: the left main coronary artery (trunk), the left anterior descending artery or anterior interventricular branch (LAD) and its branches, the left circumflex coronary artery (OC) and its branches, the right coronary artery (RCA) ) and its branches.

The large coronary arteries form an arterial ring and loop around the heart. The left circumflex and right coronary arteries are involved in the formation of the arterial ring, passing through the atrioventricular sulcus. The formation of the arterial loop of the heart involves the anterior descending artery from the system of the left coronary artery and the posterior descending artery from the system of the right coronary artery, or from the system of the left coronary artery - from the left circumflex artery with the left dominant type of blood supply. The arterial ring and loop are functional adaptations for the development collateral circulation hearts.

Right coronary artery

The right coronary artery (right coronary artery) departs from the right sinus of Valsalva and passes in the coronary (atrioventricular) groove. In 50% of cases, immediately at the place of origin, it gives off the first branch - the branch of the arterial cone (conus artery, conus branch, CB), which feeds the infundibulum of the right ventricle. Its second branch is the artery of the sinoatrial node (S-A node artery, SNA). leaving from the right coronary artery back at a right angle into the gap between the aorta and the wall of the right atrium, and then along its wall to the sinoatrial node. As a branch of the right coronary artery, this artery occurs in 59% of cases. In 38% of cases, the artery of the sinoatrial node is a branch of the left circumflex artery. And in 3% of cases there is a blood supply to the sino-atrial node from two arteries (both from the right and from the circumflex). In the anterior part of the coronary sulcus, in the region of the acute edge of the heart, the right marginal branch departs from the right coronary artery (acute marginal artery, acute marginal branch, AMB), more often from one to three, which in most cases reaches the apex of the heart. Then the artery turns back, lies down in back coronal sulcus and reaches the "cross" of the heart (the intersection of the posterior interventricular and atrioventricular sulci of the heart).

With the so-called right type of blood supply to the heart, observed in 90% of people, the right coronary artery gives off the posterior descending artery (PDA), which runs along the posterior interventricular groove for a different distance, giving branches to the septum (anastomosing with similar branches from the anterior descending artery, the latter usually longer than the first), the right ventricle and branches to the left ventricle. After the posterior descending artery (PDA) originates, the RCA continues beyond the cross of the heart as the right posterior atrioventricular branch along the distal part of the left atrioventricular sulcus, terminating in one or more posterolateral branches supplying the diaphragmatic surface of the left ventricle. . On the posterior surface of the heart, immediately below the bifurcation, at the point of transition of the right coronary artery into the posterior interventricular sulcus, an arterial branch originates from it, which, piercing the interventricular septum, goes to the atrioventricular node - the artery of the atrioventricular node (atrioventricular node artery, AVN).

Left coronary artery

The left coronary artery (left coronary artery) originates from the left posterior surface of the aortic bulb and exits to left side coronal sulcus. Its main trunk (left main coronary artery, LMCA) is usually short (0-10 mm, diameter varies from 3 to 6 mm) and is divided into anterior interventricular (left anterior descending artery, LAD) and envelope (left circumflex artery, LCx) branches . In 30-37% of cases, the third branch departs here - the intermediate artery (ramus intermedius, RI), which crosses obliquely the wall of the left ventricle. LAD and OB form an angle between them, which varies from 30 to 180°.

Anterior interventricular branch

The anterior interventricular branch is located in the anterior interventricular sulcus and goes to the apex, giving off the anterior ventricular branches (diagonal, diagonal artery, D) and the anterior septal (septal branch)) along the way. In 90% of cases, one to three diagonal branches are determined. Septal branches depart from the anterior interventricular artery at an angle of approximately 90 degrees, perforate the interventricular septum, feeding it. The anterior interventricular branch sometimes enters the thickness of the myocardium and again lies in the groove and often reaches the apex of the heart along it, where in about 78% of people it turns back to the diaphragmatic surface of the heart and for a short distance (10-15 mm) rises up along the posterior interventricular groove. In such cases, it forms a posterior ascending branch. Here it often anastomoses with the terminal branches of the posterior interventricular artery, a branch of the right coronary artery.

circumflex artery

Anatomy of the coronary arteries.

Professor, Dr. med. Sciences Yu.P. Ostrovsky

At the moment, there are many options for the classification of coronary arteries adopted in different countries and centers of the world. But, in our opinion, there are certain terminological differences between them, which creates difficulties in the interpretation of coronary angiography data by specialists of different profiles.

We have analyzed the literature on the anatomy and classification of the coronary arteries. Data literary sources compared with their own. A working classification of the coronary arteries has been developed in accordance with the nomenclature adopted in the English literature.

coronary arteries

The large coronary arteries form an arterial ring and loop around the heart. The left circumflex and right coronary arteries are involved in the formation of the arterial ring, passing through the atrioventricular sulcus. The anterior descending artery from the system of the left coronary artery and the posterior descending artery from the system of the right coronary artery, or from the system of the left coronary artery - from the left circumflex artery with the left dominant type of blood supply participate in the formation of the arterial loop of the heart. The arterial ring and loop are a functional device for the development of collateral circulation of the heart.

Right coronary artery

Right coronary artery(right coronary artery) departs from the right sinus of Valsalva and passes in the coronary (atrioventricular) groove. In 50% of cases, immediately at the place of origin, it gives off the first branch - the branch of the arterial cone (conus artery, conus branch, CB), which feeds the infundibulum of the right ventricle. Its second branch is the sinoatrial node artery (S-A node artery, SNA). leaving the right coronary artery back at a right angle into the gap between the aorta and the wall of the right atrium, and then along its wall to the sinoatrial node. As a branch of the right coronary artery, this artery occurs in 59% of cases. In 38% of cases, the artery of the sinoatrial node is a branch of the left circumflex artery. And in 3% of cases there is a blood supply to the sino-atrial node from two arteries (both from the right and from the circumflex). In the anterior part of the coronary sulcus, in the region of the acute edge of the heart, the right marginal branch departs from the right coronary artery (acute marginal artery, acute marginal branch, AMB), more often from one to three, which in most cases reaches the apex of the heart. Then the artery turns back, lies in the back of the coronary sulcus and reaches the "cross" of the heart (the intersection of the posterior interventricular and atrioventricular sulcus of the heart).

The branches of the right coronary artery vascularize: right atrium, part of the anterior, entire posterior wall of the right ventricle, a small section of the posterior wall of the left ventricle, atrial septum, the posterior third of the interventricular septum, the papillary muscles of the right ventricle and the posterior papillary muscle of the left ventricle.

Left coronary artery

Left coronary artery(left coronary artery) starts from the left posterior surface of the aortic bulb and goes to the left side of the coronary sulcus. Its main trunk (left main coronary artery, LMCA) is usually short (0-10 mm, diameter varies from 3 to 6 mm) and is divided into anterior interventricular (left anterior descending artery, LAD) and envelope (left circumflex artery, LCx) branches . In 30-37% of cases, the third branch departs here - the intermediate artery (ramus intermedius, RI), which crosses obliquely the wall of the left ventricle. LAD and OB form an angle between them, which varies from 30 to 180°.

Anterior interventricular branch

The circumflex branch of the left coronary artery is located in the left part of the coronary sulcus and in 38% of cases gives the first branch to the artery of the sinoatrial node, and then the artery of the obtuse marginal artery (obtuse marginal artery, obtuse marginal branch, OMB), usually from one to three. These fundamentally important arteries feed the free wall of the left ventricle. In the case when there is a right type of blood supply, the circumflex branch gradually becomes thinner, giving branches to the left ventricle. With a relatively rare left type (10% of cases), it reaches the level of the posterior interventricular sulcus and forms the posterior interventricular branch. With an even rarer, so-called mixed type, there are two posterior ventricular branches of the right coronary and from the circumflex arteries. The left circumflex artery forms important atrial branches, which include the left atrial circumflex artery (LAC) and the large anastomosing auricular artery.

The branches of the left coronary artery vascularize the left atrium, the entire anterior and most of the posterior wall of the left ventricle, part of the anterior wall of the right ventricle, the anterior 2/3 of the interventricular septum, and the anterior papillary muscle of the left ventricle.

Types of blood supply to the heart

The type of blood supply to the heart is understood as the predominant distribution of the right and left coronary arteries on the posterior surface of the heart.

The anatomical criterion for assessing the predominant type of distribution of the coronary arteries is the avascular zone on the posterior surface of the heart, formed by the intersection of the coronary and interventricular sulci, - crux. Depending on which of the arteries - right or left - reaches this zone, the predominant right or left type of blood supply to the heart is distinguished. The artery reaching this zone always gives off a posterior interventricular branch, which runs along the posterior interventricular sulcus towards the apex of the heart and supplies blood to the posterior part of the interventricular septum. Another anatomical feature is described to determine the predominant type of blood supply. It is noted that the branch to the atrioventricular node always departs from the predominant artery, i.e. from the artery, which is of the greatest importance in the supply of blood to the posterior surface of the heart.

Thus, with predominant right type of blood supply to the heart The right coronary artery supplies the right atrium, the right ventricle, the posterior part of the interventricular septum, and the posterior surface of the left ventricle. The right coronary artery is represented by a large trunk, and the left circumflex artery is poorly expressed.

With predominant left type of blood supply to the heart the right coronary artery is narrow and terminates in short branches on the diaphragmatic surface of the right ventricle, and the posterior surface of the left ventricle, the posterior part of the interventricular septum, the atrioventricular node and most of the posterior surface of the ventricle receive blood from the well-defined large left circumflex artery.

In addition, there are also balanced type of blood supply. in which the right and left coronary arteries contribute approximately equally to the blood supply to the posterior surface of the heart.

The concept of "primary type of blood supply to the heart", although conditional, is based on the anatomical structure and distribution of the coronary arteries in the heart. Since the mass of the left ventricle is much larger than the right one, and the left coronary artery always supplies blood to most of the left ventricle, 2/3 of the interventricular septum and the wall of the right ventricle, it is clear that the left coronary artery is predominant in all normal hearts. Thus, in any type of coronary blood supply, the left coronary artery is predominant in the physiological sense.

Nevertheless, the concept of "predominant type of blood supply to the heart" is valid, it is used to assess anatomical findings during coronary angiography and is of great practical importance in determining indications for myocardial revascularization.

For topical indication of lesions, it is proposed to divide the coronary bed into segments.

Dotted lines in this scheme highlight the segments of the coronary arteries.

So in the left coronary artery in the anterior interventricular branch it is divided into three segments:

1. proximal - from the place of origin of the LAD from the trunk to the first septal perforator or 1DV.

2. medium - from 1DV to 2DV.

3. distal - after the discharge of 2DV.

In circumflex artery It is also customary to distinguish three segments:

1. proximal - from the mouth of the OB to 1 VTK.

3. distal - after the departure of 3 VTK.

Right coronary artery divided into the following main segments:

1. proximal - from the mouth to 1 wok

2. medium - from 1 wok to the sharp edge of the heart

3. distal - up to the RCA bifurcation to the posterior descending and posterolateral arteries.

Coronary angiography

Coronary angiography(coronary angiography) is an X-ray visualization of the coronary vessels after the introduction of a radiopaque substance. The x-ray image is immediately recorded on 35 mm film or digital media for further analysis.

Currently, coronary angiography is the "gold standard" for determining the presence or absence of stenosis in coronary disease.

The purpose of the coronary angiography is the definition coronary anatomy and the degree of narrowing of the lumen of the coronary arteries. Information obtained during the procedure includes determining the location, extent, diameter and contours of the coronary arteries, the presence and degree of coronary obstruction, characterization of the nature of the obstruction (including the presence of an atherosclerotic plaque, thrombus, dissection, spasm or myocardial bridge).

The data obtained determine the further tactics of treating the patient: coronary artery bypass surgery, intervention, drug therapy.

To conduct high-quality angiography, selective catheterization of the right and left coronary arteries is necessary, for which a large number of diagnostic catheters of various modifications have been created.

The study is being carried out under local anesthesia and NLA through arterial access. The following arterial accesses are generally recognized: femoral arteries, brachial arteries, radial arteries. Transradial access to Lately won a strong position and became widely used due to its low trauma and convenience.

After puncture of the artery, diagnostic catheters are inserted through the introducer, followed by selective catheterization of the coronary vessels. contrast agent dosed using an automatic injector. Shooting is performed in standard projections, the catheters and intraduser are removed, and a compression bandage is applied.

Basic angiographic projections

During the procedure, the goal is to obtain the maximum full information about the anatomy of the coronary arteries, their morphological characteristics, the presence of changes in the vessels with exact definition localization and nature of lesions.

To achieve this goal, coronary angiography of the right and left coronary arteries is performed in standard projections. (Their description is given below). If it is necessary to conduct a more detailed study, shooting is carried out in special projections. This or that projection is optimal for the analysis of a certain section of the coronary bed and allows you to most accurately identify the features of the morphology and the presence of pathology in this segment.

Below are the main angiographic projections with an indication of the arteries for visualization of which these projections are optimal.

For left coronary artery There are the following standard projections.

1. Right anterior oblique with caudal angulation.

RAO 30, Caudal 25.

2. Right anterior oblique view with cranial angulation.

RAO 30, cranial 20

LAD, its septal and diagonal branches

3. Left anterior oblique with cranial angulation.

LAO 60, cranial 20.

Orifice and distal segment of the LCA trunk, middle and distal segment of the LAD, septal and diagonal branches, proximal segment of the OB, VTK.

The coronary or coronary artery plays an important role in the coronary blood supply. human heart consists of muscles that are constantly, without interruption, are in work. For normal operation muscles need a constant flow of blood, which carries the necessary nutrients. These pathways are precisely involved in the blood supply to the muscles of the heart, that is, the coronary blood supply. On coronary blood supply accounts for about 10% of all blood that passes through the aorta.

The vessels that are located on the surface of the heart muscle are quite narrow, despite the amount of blood in percentage that passes through them. In addition, they are able to regulate blood flow themselves, depending on the needs of the heart. In general, the increase in blood flow can increase up to 5 times.

coronary arteries hearts are the only sources of blood supply to the heart, and for the supply required amount blood is solely responsible for the function of self-regulation of blood vessels. Therefore, possible stenosis or atherosclerosis of the latter is critically dangerous for human life. Developmental anomalies are also dangerous circulatory system myocardium.

Vessels, braiding the surface and internal structures myocardium, can be interconnected, creating a single network of arterial supply to the heart muscle. Connection of the network of vessels is absent only at the edges of the myocardium, since such places are fed by separate terminal vessels.

Everyone's blood supply individual person may differ significantly and is individual. However, one can note the presence of two trunks of the coronary artery: right and left, which originate from the aortic root.

The normal development of coronary vessels leads to the formation of a vasculature, which, by its appearance remotely resembles a crown or crown, in fact, from this their name was formed. Adequate blood flow is very great importance for normal and adequate functioning of the heart muscle. In the case of abnormal development of the vascular network, designed to provide blood supply to the heart muscle, significant problems can arise for the latter.

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Doctors opinion...

Abnormal development of the vasculature of the heart occurs not so often, up to 2% of all cases. It refers only to anomalies that lead to serious violations. For example, in the case of the formation of the beginning of the left coronary artery from the pulmonary trunk instead of the aorta. As a result, the heart muscle receives venous blood, which is poor in oxygen and nutrients. The situation is even more aggravated by the lack of pressure in the pulmonary trunk, the blood is not only poor, it also comes in insufficient quantities.

Anomalies of this type are called vice, and they can be of two types. The first type is due to insufficient development of bypass pathways of blood flow between the two main branches of the arteries, which leads to a more severe development of the anomaly. The second type is due to well-developed detours. Then left side the heart muscle has the ability to receive the missing nutrients from the adjacent path. The second type of anomaly suggests a more stable condition of the patient, and does not pose an immediate threat to the life of the latter, but does not imply any stress.

Blood flow dominance

The anatomical location of the posterior descending branch and the anterior interventricular branch determines the dominance of blood flow. Only in the case of equally good development of both branches of the coronary blood supply, one can speak of the constancy of the areas of nutrition by each branch, and their usual branches. In the case of a better development of one of the branches, there is a shift in the branching of the branches and, accordingly, the areas for which they are responsible for feeding.

Depending on the severity of the coronary pathways, right and left types of dominance, as well as codominance, are distinguished. Uniform blood supply or codominance is noted when the posterior descending branch is fed by both branches. Right dominance is noted when the posterior interventricular branch is fed by the right coronary artery, it occurs in 70% of cases. Accordingly, the left type of dominance is noted when feeding on the neighboring bloodstream, it occurs in 10% of cases. Codominance occurs in 20% of all cases.

Right barrel

The right coronary artery supplies blood to the ventricle of the myocardium together with the right atrium, the posterior third of the septum and part of the arterial cone. Location: runs from the root along the coronal sulcus and, bypassing the edge of the myocardium, goes to the surface of the myocardial ventricle (its back part) and the lower surface of the heart. Then it branches into terminal branches: the right anterior atrial branch, the right anterior ventricular branch. In addition, it is divided into right marginal and posterior ventricular branches. As well as posterior interventricular ramification, right posterior atrial ramification, and left posterior ventricular ramification.

Left barrel

The path of the left coronary artery runs to the sternocostal surface of the myocardium between the left auricle and the pulmonary trunk, after which it branches. In 55% of all cases, the length of the latter barely reaches 10 mm.

Supplies blood to most of the interatrial septum in its posterior and anterior sides. It also feeds the left atrium and ventricle. In most cases, it has two branches, but sometimes it can branch into three, less often four branches.

The largest branches of this coronary blood flow that occur in more cases are the envelope branch and the anterior interventricular branch. Passing from their origin, they branch into smaller vessels that can connect with small vessels other branches, creating a single network.

The coronary arteries are the two main channels through which blood flows to the heart and its elements.

Another common name for these vessels is coronary. They surround the contractile muscle from the outside, feeding its structures with oxygen and essential substances.

There are two coronary arteries leading to the heart. Let's take a closer look at their anatomy. Right feeds the ventricle and atrium located on its side, and also carries blood to a 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. Further, the vessel goes around the myocardium along the atrioventricular groove and continues to the back wall of the organ to the longitudinal one. The right coronary artery also reaches the apex of the heart. Throughout its length, it gives one branch to the right ventricle, namely to its anterior, posterior wall and papillary muscles. Also, this vessel has branches extending to the sinoaricular node and the interventricular septum.

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

This vessel is quite wide, but at the same time short. Its length is about 10 mm. Outgoing 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 over almost the entire interventricular septum. The upper of the septal branches extends to the right ventricle, the anterior wall and to its papillary muscle.

The left coronary artery gives 3 or 4 large branches that have importance. 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 cardiac muscle and in some places plunges into it, and then passes through the thickness of 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, lies in the transverse groove towards the obtuse edge of the heart and, bending around it, stretches along the posterior wall of the left ventricle. Then it goes to descending 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 feeds the sinoaricular node.

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

Pathologies of the arteries

Due to the fact that the 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 lethal outcome. If one of the coronary arteries supplying it is blocked, it is necessary to without fail carry out stenting or shunting aimed at restoring blood flow. Depending on which vessel feeds 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 assigned to the left coronary artery.
Balanced. The posterior wall of the left ventricle is equally supplied by both coronary arteries.

After determining the type of blood supply, the doctor can determine which of the coronary arteries or its branches is blocked and needs to be corrected promptly.

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.

Arteries of the heart - aa. coronariae dextra et sinistra,coronary arteries, right and left, start from bulbus aortae below the superior margins of the semilunar valves. Therefore, during systole, the entrance to the coronary arteries is covered by valves, and the arteries themselves are compressed by the contracted muscle of the heart. As a result, during systole, the blood supply to the heart decreases: blood enters the coronary arteries during diastole, when the inlets of these arteries located at the mouth of the aorta are not closed by the semilunar valves.

Right coronary artery, a. coronaria dextra

, exits the aorta, respectively, the right semilunar valve and lies between the aorta and the ear of the right atrium, outside of which it goes around the right edge of the heart along the coronary sulcus and passes to its posterior surface. Here it continues into interventricular branch, r. interventricularis posterior. The latter descends along the posterior interventricular sulcus to the apex of the heart, where it anastomoses with a branch of the left coronary artery.

Branches of the right coronary artery vascularize: right atrium, part of the anterior wall and the entire posterior wall of the right ventricle, a small portion of the posterior wall of the left ventricle, interatrial septum, posterior third of the interventricular septum, papillary muscles of the right ventricle and posterior papillary muscle of the left ventricle. ,

Left coronary artery, a. coronaria sinistra

, leaving the aorta at its left semilunar valve, also lies in the coronary sulcus anterior to the left atrium. Between the pulmonary trunk and the left ear, it gives two branches: thinner front, interventricular, ramus interventricularis anterior, and the larger left one, envelope, ramus circumflexus.

The first descends along the anterior interventricular sulcus to the apex of the heart, where it anastomoses with a branch of the right coronary artery. The second, continuing the main trunk of the left coronary artery, goes around the heart on the left side along the coronary sulcus and also connects to the right coronary artery. As a result, an arterial ring is formed along the entire coronal sulcus, located in a horizontal plane, from which branches perpendicularly depart to the heart. The ring is a functional device for the collateral circulation of the heart. Branches of the left coronary artery vascularize the left atrium, the entire anterior wall and most of the posterior wall of the left ventricle, part of the anterior wall of the right ventricle, the anterior 2/3 of the interventricular septum, and the anterior papillary muscle of the left ventricle.

Observed various options development of the coronary arteries, as a result of which there are different ratios of blood supply pools. From this point of view, there are three forms of blood supply to the heart: uniform with the same development of both coronary arteries, left vein and right vein. In addition to the coronary arteries, "additional" arteries from the bronchial arteries, from bottom surface aortic arches near the arterial ligament, which is important to take into account so as not to damage them during operations on the lungs and esophagus and thus not worsen the blood supply to the heart.

Intraorgan arteries of the heart:

from the trunks of the coronary arteries and their large branches according to 4 chambers of the heart, branches of the atria depart (rr. atriales) and their ears rr. auriculares), branches of the ventricles (rr. ventriculares), septal branches (rr. septales anteriores et posteriores). Having penetrated into the thickness of the myocardium, they branch out according to the number, location and structure of its layers: first in the outer layer, then in the middle (in the ventricles) and, finally, in the inner one, after which they penetrate into the papillary muscles (aa. papillares) and even into the atrium -ventricular valves. Intramuscular arteries in each layer follow the course of the muscle bundles and anastomose in all layers and departments of the heart.

Some of these arteries have a highly developed layer in their wall. involuntary muscles, with the reduction of which there is a complete closure of the lumen of the vessel, which is why these arteries are called "closing". A temporary spasm of the "closing" arteries can lead to a cessation of blood flow to this area of the heart muscle and cause a myocardial infarction.

Diseases of the heart and associated vascular system in currently have become a huge problem in modern human civilization. At the same time, the more prosperous the society is in terms of living standards, the more serious the situation is in terms of the number of people suffering from coronary heart disease.

What is coronary heart disease?

The human heart is a very complex, finely tuned and sensitive mechanism, the purpose of which can be reduced to one function - the delivery of substances necessary for proper functioning to each cell of the body.

In addition to the heart itself, blood vessels also participate in this activity, the system of which permeates the human body, which fully ensures the uninterrupted delivery of everything necessary to the cells of the organs most distant from the heart.

Crown

lar artery and its role in the human life support system

The full operation of this system is ensured by the heart muscle, the rhythm and completeness of contractions of which also depend on the normal supply of blood - the carrier of everything necessary for normal life human body. Blood flows to the heart muscle through vessels called coronary arteries.

Hence the names: artery, etc. And if the required blood flow in the coronary arteries is reduced, the heart muscle is deprived of nutrition, which leads to coronary diseases such as heart failure, abnormal heart rhythms and heart attacks. The reason for everything is coronary atherosclerosis.

What is it and why is it scary?

Over time and under the influence of many factors, which will be discussed later, fats and lipids settle on the walls of the arteries, forming constantly growing sticky plaques that create obstacles to normal blood flow.

Thus, the lumen of the artery gradually decreases, and less and less oxygen is supplied to the heart, which leads to the appearance of pain in the retrosternal region - angina pectoris. At first, these pains can disturb a person only when heavy loads, but gradually become a response to even small efforts, and subsequently may occur at rest.

Complications and concomitant diseases of atherosclerosis

Atherosclerosis of the coronary arteries inevitably leads to such a disease as the heart. It is worth noting that the so-called heart diseases claim incomparably more lives than oncological or infectious diseases- and it is in the most developed countries.

Damage to the coronary arteries naturally renders negative impact on the heart muscle, which in turn causes angina pectoris, heart attacks, heart attacks, disorders heart rate, heart failure and, worst of all, cardiac death.

Symptoms in coronary heart disease

The human body has an individual anatomical structure. And the anatomy of the heart, the arteries that feed it, each has its own characteristics. The heart is fed by two coronary arteries - right and left. And it is the left coronary artery that provides the heart muscle with oxygen in the amount required for its normal functioning.

With a decrease in blood flow in it, retrosternal pain occurs - symptoms of angina pectoris, and their appearance is often not associated with special loads. A person can experience them both while at rest, such as in sleep, and while walking, especially over rough terrain or stairs. Such pains can be provoked and weather conditions: in winter, in cold and windy weather, they can disturb more often than in summer.

What you need to know about angina pectoris

First of all, this disease is the result of acute heart failure, provoked by insufficient blood supply to the heart muscle due to the fact that the left coronary artery is affected. Another name for the disease, known to many from Russian classical literature, is angina pectoris.

A characteristic manifestation of this disease is the pain already described earlier. But it is also possible (most often on initial stages) sensations not of pain as such, but of pressure in the chest, burning. Moreover, the amplitude of pain has a fairly wide range: from almost insignificant to unbearably sharp. Its distribution area is located mainly on the left side of the body and rarely on the right. Pain may appear in the arms, shoulders. Affect the neck and lower jaw.

Pain is not constant, but paroxysmal, and their duration is mainly from 10 to 15 minutes. Although there are up to half an hour - in this case, a heart attack is possible. Attacks can be repeated with an interval of 30 times a day to once a month or even years.

Factors Contributing to the Development of Coronary Heart Disease

As mentioned earlier, coronary heart disease is the result of damage to the coronary arteries. There are several generally recognized factors in which the coronary artery that feeds the heart muscle becomes unusable.

The first of these can rightly be called redundantly high level in human blood cholesterol, which, due to its viscosity, is the root cause of the formation of plaques on the walls of the artery.

The next risk factor contributing to the development of heart disease, namely heart attack, is hypertension - excess blood pressure.

Huge damage to the coronary arteries of the heart is obtained from smoking. The risk of damage to the walls of the arteries increases many times due to the harmful effects on them chemical compounds that make up tobacco smoke.

The next risk factor that increases the likelihood of damage to the coronary vessels is a disease such as diabetes mellitus. With this disease, atherosclerosis is exposed to the entire vascular system human, and significantly increases the likelihood of heart disease at an earlier age.

Heredity can also be attributed to risk factors affecting the occurrence of heart disease. Especially if the fathers of potential patients had heart attacks, or death occurred as a result of coronary diseases under the age of 55, and for mothers - up to 65 years.

Prevention and treatment of coronary heart disease

Avoid or reduce the risk of getting sick coronary diseases hearts can, if performed, and strictly and continuously, several simple recommendations, which include healthy lifestyle life, rejection of bad habits, reasonable physical exercise and annual check-ups.

The treatment of coronary heart disease includes several options: drug therapy and cardiac surgery. The most common is coronary artery bypass grafting, in which blood is sent to the heart muscle along a bypass route: along a segment of a healthy vessel sewn parallel to the affected area of the aorta, taken from the patient himself. The operation is complex, and after it the patient needs a long period rehabilitation.

Another type of treatment is angioplasty of the coronary artery using a laser. This option is more gentle and does not require dissection of large segments of the body. The affected area of the coronary artery is reached through the vessels of the shoulder, thigh or forearm.

Unfortunately, no matter what operations are performed, even the most successful of them do not get rid of atherosclerosis. Therefore, in the future it is necessary to comply with all medical prescriptions, this applies not only medical preparations but also the recommended diet.