Anatomic and functional arrangement of subepicardial arterial system in human heart
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МЕДИЦИНСКИЙ ВЕСТНИК СЕВЕРНОГО КАВКАЗА
2016. Т. 11. № 2
medical news of north caucasus
2016. Vоl. 11. Iss. 2
© Group of authors, 2016 UDC 611. 13:616. 12
DOI — http: //dx. doi. org/10. 14 300/mnnc. 2016. 11 041 ISSN — 2073−8137
ANATOMIC AND FUNCTIONAL ARRANGEMENT OF SUBEPICARDIAL ARTERIAL SYSTEM IN HUMAN HEART
Korobkeev A. A., Dolgashova M. A., Lezhnina O. Yu. Stavropol State Medical University, Russian Federation
СУБЭПИКАРДИАЛЬНОГО АРТЕРИАЛЬНОГО РУСЛА СЕРДЦА ЧЕЛОВЕКА
Ставропольский государственный медицинский университет, Российская Федерация
The subepicardial arterial beds were studied in 60 hearts of people aged 21−60. The structural and functional values were identified for the coronary bed of people in their first and second mature ages, with the left, right, and equal types of coronary branching.
The presented morpho-functional arrangement of the subepicardial arterial bed describes specific features about vascularization in various topographic parts of the organ under investigation.
Key words: coronary arteries, structural and functional arrangement, morpho-functional indicators, first and the second stages of mature age
Изучено артериальное субэпикардиальное русло 60 сердец людей от 21 года до 60 лет. Определены структурно-функциональные показатели коронарного русла людей первого и второго периодов зрелого возраста с левовенечным, правовенечным и равномерным вариантами ветвлений венечных артерий.
Представленная морфофункциональная организация субэпикардиального артериального русла сердца характеризует особенности васкуляризации различных топографических отделов органа.
Ключевые слова: венечные артерии, структурно-функциональная организация, морфофункциональные показатели, первый и второй периоды зрелого возраста
Ischemic heart disease is rated among the most common mortality causes nowadays [2, 8, 10]. If compared to well-developed nations, in Russia this disease accounts for 3−9 times as many deaths [1, 11]. This explains the extensive interest that both applied healthcare and morpho-cardiology take in the structural arrangement of the arterial bed in human heart, in view of its morpho-functional features.
Literature has been studied focusing on age-specific subepicardial arterial branchings [3−7, 9]- however there is no systemic data on the structural and functional arrangement of vascular bifurcations of coronary arteries (CA), which would take into account their major morpho-functional indicators at various types of CA branching in the first and the second stages of mature age.
Aim of study was to offer a view on the structure of the human subepicardial arterial bed in the first and the second stages of mature age based on the structural and functional arrangement of macro-vascular CA branching and their secondary arborizations.
Material and Methods. Subepicardial CA branches were investigated from 60 hearts obtained through autopsy from male and female bodies in their first and second stages of maturity (21−60 yrs) who were killed in accidents or passed away due to a pathology not involving cardiovascular system.
Anatomic, morphometric, histological, and X-ray methods were employed to study arterial angioarchi-
tecture and cross sections of the CA and their branches. The coronaries were studied, with the respective data processed and comparative analysis done, using special computer software (Videotest-Morphology, 5. 0). The branching angles were broken in three groups (below 45°- 45°-90°- above 90°). The obtained morpho-functional indicators for vascular branching allowed developing effective morpho-mathematical models for CA and their branches as well as respective graphs for the alternating total cross section (ZSsect).
Results and Discussion. Comparative analysis of CA total cross section at various types of branching in people in their first stage of the mature age has shown that in all the hearts with left coronary, right coronary and equal CA branching the total cross section of the branches in the left coronary artery (LCA) prevailed over the ZSsect in the vascular branching of the right coronary artery (RCA) except their end-points in case of right coronary branching where the rCa total cross section exceeds that of the LCA.
Comparative analysis of the total CA opening in the second stage of the mature age has shown that in the major area in case of left coronary and equal type of coronary arborization ZSsect of the main branches of the LCA dominates over the ZSsect of the RCA. The only exception to it was the right coronary branching where the total opening of the LCA was above that of the RCA at the initial parts alone.
Comparative analysis of the ZSsect of CA at various types of branching in the first stage of the mature age has revealed the prevalence of the total opening in case of left coronary type compared to the equal and the right coronary arborization types. The maximum values of the total cross section of the RCA main branches were registered in case of the right coronary type of arborization (compared to the left and equal coronary types) in the most area of the branch coverage.
The prevalence of the LCA ZSsect in the second stage of the mature age was to be observed in all the initial parts of its branching in case of left coronary arborization as well as at the end-points at equal-coronary arborization with minimal values for the respective indices in case of the right coronary type of branching.
The total cross section of the RCA is maximal at equal coronary branching at the initial parts of the CA arborizations. In case of right coronary branching the total cross section was at its highest value at the end-points of its branch coverage if compared to the left coronary type of branching where the total vascular opening was at its minimum.
Comparative analysis of the total LCA opening at various types of coronary arborization through the investigated age stages has shown its maximum values and prevalence over the entire area of branching only in case of the left coronary type in the first stage of the mature age. In case of the right coronary arborization in the first stage of the mature age, LCA ZSsect also prevails in the largest part of its coverage except the initial parts where the indices in question in the first and the second mature-age stages are much the same. The equal type of coronary artery arborization can be described with larger values for the ZSsect in relation to the main LC branches in the second mature age, from its initial parts up to entering the myocardium, compared to the first mature age.
The total opening of the main RCA branches is prevailing in the largest area in all variants of coronary branching in the second mature age whereas the only exception were the initial parts at the right coronary type, and the endpoints at the left coronary type of artery branching where they were about equal or slightly below if put against the first mature age. The maximal values of the RCA branches ZSsect were identified in the second mature age in case of equal coronary branching, and in the first mature age — at the right coronary type of branching, if compared to the left coronary and the equal coronary types.
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In most of the studied age stages at all types of coronary arborization, the total number of vascular CA branchings with angles within the range of 45°-90° was above the number of those with an angle below 45° as well as above 90°.
In those in their first mature age, at the left coronary type of arborization, the share of the angles 45°-90°, below 45°, and above 90° was 55%, 25%, and 20% respectively. In case of the right coronary type, the angles of the affiliated branches lying within 45°-90° were observed in 76.5% of the cases, while another 23.5% were identified as angles below 45°. The equal-coronary type of arborization revealed 61.1% of branching angles at 45°-90°, 27.8% of cases below 45°, with the rest of those (11.1%) — above 90°.
In cases of the second mature age, with the left coronary type of arborization, the balance of the branching angles was as follows: 45°-90° - 73.3%- below 45° - 20%, and over 90° - 6.7%. 70.6% of the cases with the right coronary branching were observed to have the angles of 45°-90°, 11.8% - below 45°, with another 17.6% being above 90°. However, in the cases of CA equal branching the values were distributed like 55%, 25%, and 20% for the angles of 45°-90°, below 45°, and above 90°, respectively.
At all coronary branching types, the maximal branching with a bigger deviation angle and smaller Ssect (compared to less-deviating branches with a larger Ssect) was 78.2% for the first mature age, while in the second mature age there were fewer cases like that (76.9%). Along with that, there were vascular branching types identified where more deviating branches had a larger value of the Ssect compared to those with a smaller deviation angle and a lower value of the Ssect. Their share in the first and in the second mature ages was 20% and 23.1%, respectively. The arborization types with affiliated branches of equal-angle deviation and showing various Ssect were identified only in the first mature age, in 1.8% of all the cases.
Conclusions. Therefore, the dynamics for the total opening change in the studied blood vessels correlates with the topography of the CAs and that of their branches under various types of coronary arborization through the age stages of the postnatal ontogenesis, which is reflected in the specific features of the morpho-mathematical models.
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