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Understanding coronary arterial anatomy in the congenitally malformed heart*

Published online by Cambridge University Press:  18 January 2013

Robert H. Anderson ,
Ing-Sh Chiu ,
Diane E. Spicer  and
Anthony J. Hlavacek
Robert H. Anderson*
Affiliation:
Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
Ing-Sh Chiu
Affiliation:
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Diane E. Spicer
Affiliation:
Division of Pediatric Cardiology, University of Florida, Gainesville, United States of America Congenital Heart Institute of Florida, Saint Petersburg, Florida, United States of America
Anthony J. Hlavacek
Affiliation:
Division of Cardiology, Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, United States of America
*
Correspondence to: Professor R. H. Anderson, BSc, MD, FRCPath, 60 Earlsfield Road, London SW18 3DN, United Kingdom. Tel.: +44 20 8870 4368; E-mail: sejjran@ucl.ac.uk
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Abstract

With the development of three-dimensional techniques for imaging, such as computed tomography and magnetic resonance imaging, it is now possible to demonstrate the precise sinusal origin and epicardial course of the coronary arteries with just as much accuracy as can be achieved by the morphologist holding the heart in his or her hands. At present, however, there is no universally accepted convention for categorising the various patterns found when the heart is congenitally malformed. In this review, we show how, to provide such a convention, it is necessary to take note not only of the sinusal origin of the three major coronary arteries, but also the relationship of the aortic root relative to the cardiac base. We summarise the evidence showing how the proximal portions of the developing coronary arteries grow into the aortic valvar sinuses subsequent to the separation of the aortic root from the subpulmonary infundibulum. We also discuss the evidence showing that the subpulmonary myocardium is impervious to the passage of epicardial coronary arteries, and suggest that the process of septation itself plays an integral role in guiding the arteries into the two aortic sinuses that are adjacent to the pulmonary root. We then show how marriage of convenience between the epicardial coronary arteries and the aortic valvar sinuses provides a good explanation for the known variations found in the setting of transposition. We point out that it is the absence of septation that likely governs the patterns seen in the setting of a common arterial trunk.

Keywords

Anterior interventricular arteryright coronary arterycircumflex coronary arterytranspositioncommon arterial trunk
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 6: A Lifelong Interdisciplinary Approach to Common Arterial Trunk, Transposition of the Great Arteries, and Other Evolving Challenges in Paediatric and Congenital Cardiac Disease , December 2012 , pp. 647 - 654
Copyright
Copyright © Cambridge University Press 2012

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Footnotes

*

Presented at the 12th Annual International Symposium on Congenital Heart Disease, February 17–21, 2012, All Children's Hospital, Saint Petersburg, Florida, United States of America.

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