Vascularization of the Heart

Introduction to Cardiac Vascularization

• Germán Lombo introduces the topic of heart vascularization, focusing on arterial irrigation, venous drainage, and lymphatic drainage.

• The heart is described as a contractile pump that circulates oxygen-rich blood through arteries and returns deoxygenated blood via veins.

Importance of Coronary Arteries

• The heart requires an arterial system for irrigation and a venous system for drainage; coronary arteries are crucial for supplying oxygenated blood.

• There are variations in literature regarding coronary anatomy, including differences in artery count and naming conventions.

Anatomy of Coronary Arteries

• Coronary arteries encircle the heart like a crown; they originate from the aorta at the level of the aortic sinuses (sinuses of Valsalva).

• The right coronary artery arises from the right sinus, while the left coronary artery originates from the left sinus.

Left Coronary Artery Details

• The left coronary artery travels between the pulmonary trunk and left atrium, reaching the interventricular sulcus.

• It bifurcates into two terminal branches: anterior interventricular artery (also known as descending anterior artery) and circumflex artery.

Branches of Left Coronary Artery

• Before bifurcation, it may give off collateral branches such as:

• A branch to the anterior part of the aortic sheath.

• Atrial branches directed towards the left atrium.

Anterior Interventricular Artery Characteristics

• This artery runs along the anterior interventricular sulcus to reach the apex and often extends to part of the inferior surface.

• It can form anastomoses with posterior interventricular artery typically arising from right coronary artery.

Collateral Branches of Anterior Interventricular Artery

• Key collateral branches include:

• Right ventricular branches for supplying right ventricle.

• Left ventricular branches for supplying left ventricle.

• Septal branches for septum intervention.

Specific Branches Related to Right Ventricular Supply

• Notable right ventricular supply includes:

• Infundibular branch (left), also known as "butterfly" or "conus arteriosus" branch.

• Marginal branch (right), which connects with marginal artery from right coronary.

Overview of Cardiac Anatomy: Anterior Interventricular Artery and Its Branches

Description of the Right and Left Branches

• The anterior interventricular artery has branches on both the right and left sides, with specific anastomoses between them.

• The left branches are variable in number, known as diagonal branches, which run obliquely across the surface of the left ventricle, designated from proximal to distal (first diagonal, second diagonal, etc.).

Anastomoses and Blood Supply

• The anterior septal arteries (12 to 15 in number) penetrate the interventricular septum, supplying two-thirds of its anterior portion. The posterior third is supplied by posterior septal arteries from the posterior interventricular artery.

• These posterior septal arteries form anastomoses with anterior septal arteries, creating additional points for blood supply.

Key Features of Specific Arteries

• The circumflex artery follows a path along the coronary sulcus towards the inferior face of the left ventricle but typically does not reach the posterior interventricular sulcus.

• It gives rise to ascending branches that supply the left atrium and descending branches for the left ventricle; notably, one branch may supply the sinoatrial node in about 40% of cases.

Marginal Branches

• The marginal artery runs along the heart's left border; some literature refers to descending branches collectively as obtuse marginal branches (designated as om1 or om2), regardless of their quantity.