Anatomy of the arteries of the heart. Blood and lymph vessels of the heart

On the this moment There are many variants of classifications 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 from literary sources are 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

From an anatomical point of view, the coronary artery system is divided into two parts - right and left. From a surgical perspective, 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 anterior descending artery from the system of the left coronary artery and posterior descending, 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 a functional device for the development of collateral circulation of the heart.

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), which leaves 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 (the branch of the acute edge, 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).

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 feeding 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 to 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 artery (AVN).

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

The 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 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

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 groove 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 the 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 the predominant left type of blood supply to the heart, the right coronary artery is narrow and ends in short branches on the diaphragmatic surface of the right ventricle, and the posterior surface of the left ventricle, rear end 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, a balanced type of blood supply is also distinguished, 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 "the predominant type of blood supply to the heart" is valid, is used to assess anatomical findings during coronary angiography and has a large practical value when 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.

Thus, in the left coronary artery in the anterior interventricular branch, it is distinguished by 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 the circumflex artery, it is also customary to distinguish three segments:

1. proximal - from the mouth of the OB to 1 VTK.
2. medium - from 1 VTK to 3 VTK.
3. distal - after the discharge of 3 VTC.

The right coronary artery is 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 coronary angiography is to determine the 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 the patient's treatment: coronary bypass grafting, 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 performed under local anesthesia and NLA through arterial access. The following arterial accesses are generally recognized: femoral arteries, brachial arteries, radial arteries. Transradial access has recently gained a strong position and has become 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. The contrast agent is 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 most complete information about the anatomy of the coronary arteries, their morphological characteristics, the presence of changes in the vessels with an accurate determination of the location and nature of the 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 the left coronary artery, the following standard projections exist.

1. Right anterior oblique with caudal angulation.
RAO 30, Caudal 25.
OV, VTK,

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.

4. Left anterior oblique with caudal angulation (spider).
LAO 60, caudal 25.
LCA trunk and proximal LAD and OB segments.

5. To determine the anatomical relationships, a left lateral projection is performed.

For the right coronary artery, images are taken in the following standard projections.

1. Left oblique projection without angulation.
LAO 60, straight.
Proximal and middle segment of RCA, VOC.

2. Left oblique with cranial angulation.
LAO 60, cranial 25.
The middle segment of the RCA and the posterior descending artery.

3. Right oblique without angulation.
RAO 30, straight.
Middle segment of the RCA, branch of the conus arteriosus, posterior descending artery.

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

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The widespread use of selective coronary angiography and surgical interventions on the coronary arteries in recent years has made it possible to study the anatomical features of the coronary circulation of a 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 systematizing these data, we paid special attention to information from the surgical anatomy of the coronary arteries, based on the principle 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:

BUT- 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 spread of the pathological process in the arteries of the heart, and is of practical importance when choosing the method of surgical intervention in the case of ischemic disease hearts.

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 an 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 coronary sulcus, 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 - departs 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 muscular 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, the 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, is clearly visible under a thin layer of subepicardial tissue and is easily distinguished.

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. Much more branches departs to the anterior-lateral wall of the left ventricle. In functional terms, the diagonal branches are especially important (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 reference point 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 auricle 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 depart 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 section of the circumflex 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 retracted 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

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 a functional device for the development of collateral circulation of the heart.

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 (the branch of the acute edge, 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).

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 feeding 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 artery (AVN).

Left coronary artery

Anterior interventricular branch

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.

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 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 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 artery of the sinoatrial node (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 (the branch of the acute edge, 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: the right atrium, part of the anterior, the entire posterior wall of the right ventricle, a small portion of the posterior wall of the left ventricle, the interatrial 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

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 groove 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.

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 data obtained determine the further tactics of the patient's treatment: coronary bypass grafting, intervention, drug therapy.

Basic angiographic projections

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 heart is the most important organ for life human body. Through its rhythmic contractions, it carries the blood throughout the body, providing nourishment to all the elements.

The coronary arteries are responsible for supplying oxygen to the heart.. Another common name for them is coronary vessels.

The cyclical repetition of this process ensures uninterrupted blood supply, which keeps the heart in working condition.

Coronaries are a whole group of vessels that supply blood to the heart muscle (myocardium). They carry oxygen-rich blood to all parts of the heart.

The outflow, depleted of its content (venous) blood, is carried out by 2/3 of the large vein, medium and small, which are woven into a single extensive vessel - the coronary sinus. The remainder is excreted by the anterior and Tebezian veins.

When the heart ventricles contract, the shutter closes off the arterial valve. The coronary artery at this point is almost completely blocked and blood circulation in this area stops.

The flow of blood resumes after the opening of the entrances to the arteries. The filling of the sinuses of the aorta occurs due to the impossibility of returning blood to the cavity of the left ventricle, after its relaxation, because. at this time, the dampers are closed.

Important! The coronary arteries are the only possible source of blood supply for the myocardium, so any violation of their integrity or mechanism of operation is very dangerous.

Scheme of the structure of the vessels of the coronary bed

The structure of the coronary network has a branched structure: several large branches and many smaller ones.

Arterial branches originate from the aortic bulb, immediately after the valve of the aortic valve and, bending around the surface of the heart, carry out blood supply to its different departments.

These vessels of the heart consist of three layers:

Initial - endothelium;
Muscular fibrous layer;
Adventitia.

This layering makes the walls of the vessels very elastic and durable.. This contributes to proper blood flow even under conditions of high stress on the cardiovascular system, including during intense sports, which increase the speed of blood flow up to five times.

Types of coronary arteries

All vessels that make up a single arterial network, based on the anatomical details of their location, are divided into:

Basic (epicardial)
Adnexal (other branches):

Right coronary artery. Its main duty is to feed the right heart ventricle. Partially supplies oxygen to the wall of the left heart ventricle and the common septum.
Left coronary artery. Provides blood flow to all other cardiac departments. It is a branching into several parts, the number of which depends on the personal characteristics of a particular organism.
envelope branch. It is a branch from the left side and feeds the septum of the corresponding ventricle. It is subject to increased thinning in the presence of the slightest damage.
Anterior descending(large interventricular) branch. It also comes from the left artery. It forms the basis for the supply of nutrients to the heart and the septum between the ventricles.
subendocardial arteries. They are considered part of the overall coronary system, but run deep within the heart muscle (myocardium) rather than on the surface itself.

All arteries are located directly on the surface of the heart itself (except for subendocardial vessels). Their work is regulated by their own internal processes, which also control the exact volume of blood supplied to the myocardium.

Variants of dominant blood supply

Dominant, feeding the posterior descending branch of the artery, which can be either right or left.

Determine the general type of blood supply to the heart:

The right blood supply is dominant if this branch departs from the corresponding vessel;
The left type of nutrition is possible if the posterior artery is a branch from the circumflex vessel;
The blood flow can be considered balanced if it comes simultaneously from the right trunk and from the circumflex branch of the left coronary artery.

Reference. The predominant source of nutrition is determined on the basis of the total flow of blood flow to the atrioventricular node.

In the vast majority of cases (about 70%), a dominant right blood supply is observed in a person. Equivalent work of both arteries is present in 20% of people. Left dominant nutrition through the blood is manifested only in the remaining 10% of cases.

What is coronary heart disease?

Ischemic heart disease (CHD), also referred to as coronary artery disease (CHD), is any disease associated with sharp deterioration blood supply to the heart, due to insufficient activity of the coronary system.

IHD can be either acute or chronic.

Most often, it manifests itself against the background of atherosclerosis of the arteries, which occurs due to a general thinning or violation of the integrity of the vessel.

A plaque is formed at the site of damage, which gradually increases in size, narrows the lumen and thereby prevents the normal flow of blood.

The list of coronary diseases includes:

angina;
Arrhythmia;
Embolism;
Arteritis;
heart attack;
Distortion of the coronary arteries;
Death due to cardiac arrest.

Coronary disease is characterized by undulating jumps in the general condition, in which the chronic phase rapidly passes into the acute phase and vice versa.

How pathologies are determined

Coronary diseases are manifested by severe pathologies, the initial form of which is angina pectoris. Subsequently, it develops into more serious diseases, and strong nervous or physical stress is no longer required for the onset of attacks.

angina pectoris

Scheme of changes in the coronary artery

In everyday life, such a manifestation of IHD is sometimes called "toad on the chest." This is due to the occurrence of asthma attacks, which are accompanied by pain.

Initially, symptoms begin in the chest area, after which they spread to the left back, shoulder blade, collarbone and lower jaw (rarely).

Pain is the result of oxygen starvation of the myocardium, the aggravation of which occurs in the process of physical, mental work, excitement or overeating.

myocardial infarction

Cardiac infarction is a very serious condition, accompanied by the death of certain parts of the myocardium (necrosis). This is due to a continuous cessation or incomplete flow of blood into the organ, which, most often, occurs against the background of the formation of a blood clot in the coronary vessels.

blockage of a coronary artery

Sharp pain in the chest, which is given to neighboring areas;
Heaviness, tightness of breath;
Trembling, muscle weakness, sweating;
Coronary pressure is greatly reduced;
Attacks of nausea, vomiting;
Fear, sudden panic attacks.

The part of the heart that has undergone necrosis does not perform its functions, and the remaining half continues its work in the same mode. This can cause the dead section to rupture. If a person is not given urgent medical assistance, the risk of death is high.

Heart rhythm disorder

It is provoked by a spasmodic artery or untimely impulses that arose against the background of impaired conduction of the coronary vessels.

The main symptoms of manifestation:

Sensation of tremors in the region of the heart;
A sharp fading of contractions of the heart muscle;
dizziness, blurriness, darkness in the eyes;
The severity of breathing;
Unusual manifestation of passivity (in children);
Lethargy in the body, constant fatigue;
Pressing and prolonged (sometimes sharp) pain in the heart.

Rhythm failure often manifests itself due to a slowdown in metabolic processes if the endocrine system is out of order. It can also be a catalyst for long-term use of many drugs.

This concept is the definition of insufficient activity of the heart, which is why there is a shortage of blood supply to the whole organism.

Pathology can develop as a chronic complication of arrhythmia, heart attack, weakening of the heart muscle.

Acute manifestation is most often associated with the intake of toxic substances, injuries and a sharp deterioration in the course of other heart diseases.

This condition needs urgent treatment, otherwise the likelihood of death is high.

Against the background of diseases of the coronary vessels, the development of heart failure is often diagnosed.

The main symptoms of manifestation:

Violation of the heart rhythm;
Difficulty breathing;
Coughing fits;
Blurring and darkening in the eyes;
Swelling of the veins in the neck;
Swelling of the legs, accompanied by painful sensations;
Disconnection of consciousness;
Strong fatigue.

Often similar condition accompanied by ascites (accumulation of water in abdominal cavity) and liver enlargement. If the patient has persistent hypertension or diabetes, it is impossible to make a diagnosis.

coronary insufficiency

Heart failure is the most common type of ischemic disease. It is diagnosed if circulatory system partially or completely ceased to supply blood to the coronary arteries.

The main symptoms of manifestation:

Severe pain in the region of the heart;
Feeling of "lack of space" in the chest;
Discoloration of urine and its increased excretion;
Paleness of the skin, a change in its shade;
The severity of the work of the lungs;
Sialorrhoea (intense salivation);
Nausea, vomiting, rejection of the usual food.

In the acute form, the disease is manifested by an attack of sudden cardiac hypoxia due to arterial spasm. Chronic course is possible due to angina pectoris against the background of accumulation of atherosclerotic plaques.

There are three stages in the course of the disease:

Initial (mild);
Expressed;
A severe stage that, if not properly treated, can lead to death.

Causes of vascular problems

There are several factors contributing to the development of CHD. Many of them are a manifestation of insufficient care for one's health.

Important! To date, according to medical statistics, cardiovascular diseases are the number one cause of death in the world.

Every year, more than two million people die from coronary artery disease, most of whom are part of the population of "prosperous" countries, with a comfortable sedentary lifestyle.

The main causes of ischemic disease can be considered:

Tobacco smoking, incl. passive inhalation of smoke;
Eating foods high in cholesterol
Availability overweight(obesity);
Hypodynamia, as a consequence of a systematic lack of movement;
Exceeding the norm of sugar in the blood;
Frequent nervous tension;
Arterial hypertension.

There are also factors independent of a person that affect the state of blood vessels: age, heredity and gender.

Women are more resistant to such ailments and therefore they are characterized by a long course of the disease. And men more often suffer precisely from the acute form of pathologies that end in death. Surgical intervention is prescribed in case of ineffectiveness of traditional therapy. To better nourish the myocardium, coronary bypass surgery is used - they connect the coronary and external veins where the intact portion of the vessels is located. Dilation can be performed if the disease is associated with hyperproduction of the artery wall layer. This intervention involves the introduction of a special balloon into the lumen of the vessel, expanding it in places of a thickened or damaged shell.

Heart before and after chamber dilatation
Reducing the risk of complications
Own preventive measures reduce the risk of coronary artery disease. They also minimize the negative effects in rehabilitation period after treatment or surgery.
The simplest advice available to everyone:
Rejection of bad habits;
Balanced diet (special attention to Mg and K);
Daily walks in the fresh air;
Physical activity;
Control of blood sugar and cholesterol;
Hardening and sound sleep.

The coronary system is very complex mechanism who needs to be cared for. The pathology that has manifested once is steadily progressing, accumulating more and more new symptoms and worsening the quality of life, therefore, the recommendations of specialists and the observance of elementary health standards should not be neglected.
Systematic strengthening of the cardiovascular vascular system will keep the vivacity of the body and soul for many years.
Video. Angina. Myocardial infarction. Heart failure. How to protect your heart.

Rice. 70. Isolated anatomical diagram of the corono-arterial tree.

1 - left coronary artery, 2 - anterior interventricular branch, 3 - envelope branch, 4 - obtuse marginal branch, Dj and D2 - 1st and 2nd diagonal arteries, 5 - right coronary artery, 6 - cone artery, 7 - artery of the sinus node, 8 - branch of the sharp edge, 9 - posterior interventricular branch, 10 - artery of the atrioventricular node.

A - aorta. Preservation of the circle of Viessen is shown by two arrows (branches of the conus artery and right ventricular branches of the anterior interventricular artery). Preservation of the primary around the atrial ring is indicated by the large arrow.

In the future, in the work (illustrations), the indicated digital code for the designations of the coronary arteries was used.

naya anatomical diagram of the structure of the corono-arterial tree. As follows from the presented data, as well as from a multi-projection study of coronary angiograms and drawings that reproduce the structure of the coronoarterial tree on corrosive preparations, in projections corresponding to those used in coronary angiography, the former do not reflect the structure of the VA in the corresponding projections. Therefore, we present a description of the anatomy of VA in accordance with the direction and determinability of VA on corrosive preparations in the corresponding projections.

Anteroposterior projection

As follows from Figures 71-74, in the anteroposterior projection, the divergence of the trunks of the right and left VA is clearly defined. This is the only projection that allows them to be visualized regardless of the level of deviation from the sinuses of Valsalva and the degree

	Rice. 71. Corrosive preparation. Before
	back projection.	Rice. 72. Corrosive preparation. Before
	1 and 2 - 1st and 2nd facial sinuses of the aorta; Dp D2 - 1st and	Rice. 72. Corrosive preparation. Before
		back projection.
	2nd diagonal arteries; 5 - right coronary	back projection.
		1 and 2 - 1st and 2nd facial sinuses of the aorta.
		1 and 2 - 1st and 2nd facial sinuses of the aorta.

contrast regurgitation. Identification of the origin of the CA and OB of the left VA in this projection is difficult.

The projection makes it possible to visualize a number of distal diagonal branches of the LAD, as well as to assess the involvement of the LAD in the blood supply to the diaphragmatic surface of the heart.

Features of all other VAs and their branches are determined only by comparing the data of a multiprojection study.

Left coronary artery

The anatomical diagram of the distribution of the main trunks of the left VA (LAD and OB) and their relationship with the departments and structures of the heart, reproduced from corrosive preparations in the 1st and 2nd anterior oblique projections, is shown in Fig. 75.

1. Left anterior oblique view. In this projection, the trunk of the left VA is in an orthogonal projection, and therefore the assessment of its features is difficult. Visualization of the left VA trunk in this projection also depends on the level of its origin from the 2nd facial (left in the definitive heart) aortic sinus, and on the degree of reflux of the contrast agent into the aorta (with a sharp stenosis or occlusion of the left VA trunk, for example).

On the other hand, in this projection, the bifurcation (trifurcation) of the left VA is clearly visualized (Fig. 75, B; 76, 77 and 78). In this projection, the LAD goes along the right contour of the heart, and the OB and its large branches - along the left.

The LAD is usually recognized by the septal arteries that arise from it at a right angle. The identification of the intermediate branch of the left VA is also very important, since, if it exists, it is responsible for the blood supply to a significant pool, including the anterior surface of the left ventricle and the apex of the heart.

The disadvantage of the projection is the superposition of the proximal segment of the VTC with the OB.

And although in this projection the visualization of the VTC is often not difficult, the detection of constrictions

in its proximal third The 1st oblique projection is accompanied by certain difficulties.

Thus, this projection makes it possible to identify the type of branching of the left VA and structural features of the LAD, OV, and their branches. And although it does not allow assessing the state of

Rice. 75. Anatomical diagram of the distribution of the main trunks of the left coronary artery and their relationship with the departments and structures of the heart, reproduced from corrosion preparations in the 1st (B) and 2nd (A) anterior oblique projections.

Identification of the anterior interventricular branch (ALV) is easily accomplished by the presence of septal branches (SB).

In the 1st anterior oblique projection, the superposition of the envelope branch (OB) and the obtuse marginal branch (OTC) is possible, in the 2nd oblique projection in front of it, the LAD and the diagonal branch (DV) are possible.

A - aorta, LA - pulmonary artery, M - mitral valve.

	Rice. 76. Corrosive preparation. 1st (left
	anterior) oblique projection.	Rice. 77. Corrosive preparation. 1st
	Left coronary artery (1) and its branches.
		(left anterior) oblique view.

		Left coronary artery (1) and its branches,

		i - intermediate artery (a. intermedia).

		The rest of the designations are the same as in Fig. 70.

the trunk of the left VA and sometimes the proximal sections of the LAD (up to the 1st septal branch) and OB, it is very informative for assessing the large left ventricular branches of the LAD (diagonal, intermediate, septal) and OB (VTK and, in part, posterolateral (ZB) left ventricular branch).

In this projection, the LAD and OB are also separated, but it is not very informative for assessing the bifurcation zone of the left VA. With absence

Rice. 78. Selective coronarogram of the left
coronary artery.	Rice. 79. Corrosive preparation. 2nd
1st (left anterior) oblique view.
	Systems of the right (5) and left coronary arteries.
	Septal branches of the anterior interventricular
	Septal branches of the anterior interventricular
	branches (2) are shown by arrows, a typical ogy stroke
	the beating branch (3) is underlined with a dotted line.
	The rest of the designations are the same as in Fig. 70.

	Rice. 80. Corrosive preparation. 2nd	Rice. 81. Selective coronarogram of the left
	Rice. 80. Corrosive preparation. 2nd	coronary artery.
	(right anterior) oblique view.
	Right (5) and left coronal arte systems	LAD - anterior interventricular branch, DV - diagonal
		naya branch, OB - envelope branch, VTK - branch of the obtuse edge.
	Typical course of the envelope branch (3) and departure
	obtuse edge branch extending from it (4) underline	reflux of a contrast agent into the aorta, this project
	chickpea dotted line.	reflux of a contrast agent into the aorta, this project
	chickpea dotted line.	tion is very informative for assessing the condition
	The rest of the designations are the same as in Fig. 70.	tion is very informative for assessing the condition
	The rest of the designations are the same as in Fig. 70.	proximal sections of the LAD and OB and proxies
		proximal sections of the LAD and OB and proxies
		small septal branches of the LAD. According to her

but also assess the development of the right ventricular branches of the LAD. In this projection, the LAD limits the left contour of the heart, and the OB extends to the right of it (Fig. 75, A; 79-81).

The projection is also optimal for the exposure of the VTC and its departure from the OB. In this projection, the zone of divergence of the OV and VTK is located in the projection, where the indicated arterial

nye vessels are maximally diluted. Recognition of the VTC is not difficult: it is the first large branch extending from the OB, heading towards the apex.

Due to the superposition of the DW and LAD, this projection is not very informative for assessing the features of the DW.

Thus, this projection makes it possible to clearly identify the region of division of the OV and VTK, assess the state of the VTK, identify structural features of the proximal sections of the OV and LAD, and visualize the right ventricular branches of the LAD.

Right coronary artery

1. Anterior-posterior projection. This projection makes it possible to identify the origin of the trunk of the right VA from the 1st facial (right in the definitive heart) aortic sinus (see Fig. 71, 72), but is not very informative for assessing the origin of the conus artery.

2. Right anterior oblique view. It is optimal for assessing the origin (independent or from the right VA) and the following of the first large branches of the right VA (see Fig. 70, 79, 82) (cone, sinus node artery, adventitia). In this projection, the cone artery (CA) is directed downward, and the artery of the sinus node is directed upward from the right VA. The projection is also very informative for revealing the nature of the distribution of VA in the region of the infundibular part of the right ventricle. It allows to assess the following of the CA or the LAD deviation from the right VA, which is very important to know when planning operations for conotruncus malformations. Apparently, in this projection (as well as in the anteroposterior one), visualization is optimal from the passage of the OB from the right VA or the 1st facial sinus of the aorta.

The projection makes it possible to assess the degree of development of collaterals between the system of the right VA and the LAD (Fig. 83) and the filling of the distal channel of the latter (flows from the CA and VOC to the LAD). The same projection is the most informative for assessing the deviation of the PAD (from the right or left VA) and determining the type of dominant blood supply.

Rice. 82. Selective coronarogram of the right coronary artery (5).

2nd (right anterior) oblique view.

VOK - branch of the sharp edge, a.AVU - artery of the atrioventricular node, ZMZhV - posterior interventricular branch.

Rice. 83. X-ray from a corrosive preparation.

2nd (right anterior) oblique view.

Collaterals between the right coronary artery (RVA) and the anterior interventricular branch (LAD). Communication between the branches of the conus artery (CA) and the right ventricular branches (RV) through the cone veins (KB).

1st s, 2nd s. and 3rd p. - first, second and third septal branches, OB - circumflex branch, LVA - left coronary artery, PIA - posterior interventricular branch.

Rice. 84. Angiographic scheme of dominant circulation types (according to J. Dodge et al., 1988) (in the 2nd right anterior oblique projection): right (A), balanced (B), left (C).

A - left ventricular branches of the right coronary artery (shaded and shown by a dark arrow), B - paired (from the right and left VA) blood supply to the posterior interventricular branch (9) is darkened and shown by a curved arrow. C - blood supply to the PMA (9) from the system of the left VA is shaded and shown by a light arrow.

/ and 2 - 1st and 2nd facial sinuses of the aorta. The rest of the designations are the same as in Fig. 70.

Rice. 85. Corrosive preparation. Back view of the heart.

The right type of dominance of the blood circulation of the heart. Multiple PADs (9) (three of them) supplying the posterior septum, 2 - circumflex segment of the right coronary artery, 10 - artery of the atrioventricular node.

heart (Fig. 84). With the right type of dominance, the PFA moves away from the right VA (Fig. 85), with the left type, from the left VA (see Fig. 80, 81).

Usually, when studying coronarograms, information is obtained about the state of the coronary arteries - the nature, extent and localization of the pathological process are assessed. An integral part of this process is the assessment of the degree of development of collaterals and the distal bed of large VAs. (Yu.S. Petrosyan and L.S. Zingerman, 1974; S. Ilsley et ah, 1982). Meanwhile, when “reading” an angiogram, the interpretation of another issue is no less important: understanding the anatomy of the VA itself and the role of individual VAs.

in vascularization of the heart. A clear planning of coronary artery bypass surgery is unthinkable without assessing which vessel is studied on the angiogram and without identifying which parts of the heart require revascularization. In this regard, the materials presented here, we believe, may be useful to a certain extent.

in practical purposes.

Literature

1. Abdullaev F. Z., Nasedkina M. A., Mozhina A. A. et al., Characteristic features of pathological anatomy and myocardial lesions in abnormal origin of the left coronary artery from the pulmonary trunk, Arkh. Pat. - 1988. - No. 6. - S. 35-41.

2. Antipov N. V. Conduction system of the heart: detection technique, morphogenesis: Abstracts of reports. VII regional scientific conference of morphologists. - Donetsk, 1990. - S. 9-10.

3. Arutyunov V. D. Viessen-Tebezia vessels in cardiac hypertrophy and myocardial infarction: Proceedings of the 2nd Conf. Latvian pathologists. - Riga, 1962. - S. 109-111.

4. Arkhangelsky A.V. On changes in the papillary muscles of the heart in myocardial infarction. Arch. Pat. - 1959. - No. 9. - S. 48-54.

5. Aryev M. Ya., Vitushinsky V. A., Rabinerzon A. V.On collateral circulation in the heart under pathological conditions // Ter. arch. - 1935. - T. 13, issue. 3.

6. Bokeria L.A. Tachyarrhythmias. - M.: Medicine, 1989.

7. Van Praag R. Anatomy of a normal heart and a segmental approach to diagnosis // Morphology and morphometry of the heart in normal and congenital heart diseases. - M., 1990. - S. 7-31.

8. Volynsky Yu. D., Todua F. I., Mogilevsky L. S., Kokov L. S.Bronchial and systemic circulation of the lungs in surgery for congenital heart defects of the “blue” type. - 1981. - No. 3. - S. 83-84.

9. Gabain L. I., Fomin A. M. Morphological features of the bloodstream in the papillary muscles of the human heart // Systemic hemodynamics and microcirculation. - Kui byshev, 1983. - S. 23-28.

10. Dubinina R. V. On the variant anatomy of the coronary arteries with different types of blood supply to the heart // Sat. scientific works of the Arkhangelsk honey. institute. T. 1. - 1964. - S. 75-80.

11. Zinkovsky M. F., Shcherbinin V. G., Chepkaya I. L.Residual shunts after correction of atrial defects // Thoracic and heart-vessel, hir. - 1991. - No. 2. - S. 23-27.

12. Zolotova-Kostomarova M. I. Clinic and pathology of myocardial infarction: Dis. ... cand. Sciences. - M., 1951.

13. Ilyinsky, S.P., On the Vessels of Thebesia, Arch. Pat. - 1958. - T. 20, No. 5. - S. 3-11.

14. Ilyinsky S.P. Vessels of Tebezia as a variant of arteriovenous anastomoses of the heart. - L.: Lenizdat, 1962. - S. 227-233.

15. Ilyinsky S. P. Vessels of Tebezia. - L .: Medicine, 1971.

16. Ioseliani D.G. Ischemic heart disease in terms of surgical treatment: Dis. ...

Doctor of Sciences. - M., 1979.

17. Forged V. V., Anikina T. N. Surgical anatomy of human arteries. - M.: Medicine

on, 1 9 7 4 . - S. 33-37.

19. Kolesov V. I. Surgery of the coronary arteries of the heart. - L .: Medicine, 1977. - S. 26-32.

20. Konstantinov B. A. In the debate on the report of V.I. Burakovsky et al. "Basic principles of surgical treatment of Ebstein's anomaly" // Thoracic hir. - 1981. - No. 3. - S. 80-87.

21. Leporsky N. I. To the clinic of complete closure of the mouths of both coronary arteries of the heart in aortic syphilis // Ter. arch. - 1939. - T. 17, No. 4. - S. 3-16.

22. Lisitsin M. S. Types of blood supply to the heart // Vestn. hir. and border region - 1927.

- No. 9. - S. 26.

23. Puddle D. X-ray anatomy of the vascular system. - Budapest: Publishing House of the Academy of Sciences, 1973. - S. 29-33.

24. Melman E. P., Shevchuk M. G. The bloodstream of the heart and its potential reserves.

M.: Medicine, 1976.

25. Mikhailov S. S. Clinical anatomy of the heart. - M.: Medicine, 1987. - S. 184.

26. Mikhailov S. S. Ibid. - S. 190.

27. Monastyrsky L. G. Topographic and anatomical relations of the fibrous ring of the mitral valve to some anatomical formations of the heart. - 1965.

- No. 5. - S. 23-29.

28. Nagy I. [cit. according to V. V. Kovanov and T. N. Anikina (1974)].

29. Nezlin V. S. Coronary disease. - M.: Medicine, 1951.

30. Ognev B. V., Savvin V. P., Savelieva L. A. Blood vessels of the heart in normal and pathological conditions. - M., 1954.

31. Petrosyan Y. S., Abdullaev F. Z., Gharibyan V. A. Angiographic semiotics and pathophysiology of abnormal LVA discharge from the pulmonary trunk. Thoracic and heart-vessel. hir. - 1990. - No. 3. - S. 8-14.

32. Petrosyan Yu. S., Zingerman L. S. Coronary angiography. - M.: Medicine, 1974. - S. 112-125. 33. Prelatov V. A. Mitral valve annuloplasty using a support ring:

Dis. ... Doctor of Sciences. - M., 1985.

34. Rabkin I. Kh., Abugova A. M "Matevosova" L. // Coronary angiography and coronary scanning: Guide to angiography / Ed. I. X. Rabkina. - M.: Medicine, 1977. - S. 67-81.

35. Rabkin I. Kh., Abugov A. M., Shabalkin B. V. Evaluation of collateral circulation according to selective coronary angiography // Kardiologiya. - 1973. - No. 11. - S. 15.

36. Rabkin I. Kh., Matevosov A. L., Khilenko A. V. Coronary scanning in the diagnosis of coronary heart disease // Ibid. - 1974. - No. 2. - S. 5-10.

37. Rabotnikov V. S., Ioseliani D. G. The state of the distal bed of the coronary arteries in patients with coronary heart disease // Ibid. - 1978. - No. 12. - S. 41-44.

38. Ryumina E. N., Berishvili I. I., Aleksi-Meskhishvili V.V. Lung scan in pain

nyh at Fallot's tetrad before and after palliative operations // Med. radiol. - 1979.

- No. 7. - S. 23-32.

39. Savelyev V. S., Petrosyan Yu. S., Zingerman L. S. et al. Angiographic diagnosis of diseases of the aorta and its branches. - M.: Medicine, 1975.

40. Samoilova SV Anatomy of the blood vessels of the heart. - "P .: Medicine, 1970.

41. Sinev A.F. Surgical anatomy of the conduction system of the heart in complex congenital heart defects: Dis. ... Doctor of Sciences. - M., 1982.

42. Smolyannikov A. V., Naddachina T. A. Pathological anatomy of coronary insufficiency. - M., 1963.

43. Sokolov S. S. Surgical anatomy of the "dangerous zones" of the heart in the correction of acquired and congenital malformations // Vestn. hir. - 1978. - No. 11. - S. 48-56.

44. Speransky L. S. Arteries of the heart // International anatomical nomenclature: Appendix 6. - M.: Medicine, 1980. - S. 207-208.

45. Travin A. A., Mikhailin S. I., Filippov B. V., Shinkarenko A. Ya. Surgical anatomy of the arteries sinoatrial and atrioventricular nodes of the heart // Thoracic hir. - 1982. - No. 1. - S. 38-42.

46. Khubutia V. I. Clinical anatomy and operative surgery of the pericardium and coronary vessels. - Ryazan, 1974. - S. 63-103.

47. Tsoy L. A., Chevagina V. N.[cit. according to V. V. Kovanov and T. N. Anikina (1974)].

48. Tsukerman G. I., Travin A. A., Georgadze O. A. On measures to prevent ligation of the circumflex branch of the left coronary artery during mitral valve replacement // Thoracic Surgery. - 1976. - No. 4. - S. 20-24.

49. Shabalkin B.V., Belov Yu.V. Aneurysms of the posterior wall of the left ventricle of the heart. Cardiology. - 1984. - No. 7. - S. 19-23.

50. Shumakov V. I. Surgical correction of mitral valve insufficiency:

Dis. ... cand. Sciences. - M., 1959.

51. Anderson K. R., Ho S. Y., Anderson R. H. Location and vascular supply of sinus node in human heart // Brit. Heart J. - 1979. - Vol. 41. - P. 28-32.

52. Anderson R. H., Becker A. E. Cardiac Anatomy. An integrated text and color atlas. - Gower Medical Publishing. - Pt. 10. - London: Churchill Livingstone, 1980.

53. Austen W. G., Edwards J. E., Frye R. L. et al. A reporting system on patients evaluated for coronary artery disease, report of the AD Hoc. Committee for Grading of Coronary Artery Disease, Council of Cardiovascular Surgery, American Heart Association (editorial) // Circulation. - 1975. - Vol. 51.-P. 7-40.

55. Baroldi G., Scomazzoni G. Coronary circulation in the normal and pathologic heart. - Armed. Forces Institute of Pathology, 1967. - P. 248-263.

56. Becker L. C. Constriction of native coronary collaterals // Cardiovasc. Res. - 2000. - Vol. 47, No. 2. -P. 217-218.

57. Bjork L. Anastomoses between the coronary and bronchial arteries // Acta Radiol. (Diag.). - Stockholm, 1966. - Vol. 4. - P. 93-96.

58. Bjork V. O., Bjork L. Coronary artery fistula // J. Thorac. Cardiovasc. Surg. - 1965.

Vol. 4 9 . -P. 921.

59. Bogers A. J. J. C. Congenital coronary artery anomalies. Clinical and embryological aspects. (Phd. Theses). - Leiden, 1989.

60. Dabizzi R. P., Caprioli G., Aiazzi L. et al. Distribution and anomalies of coronary arteries in tetralogy of Fallot // Circulation. - 1980. - Vol. 61, No. 1. - P. 95-102.

61. DeBakker M. J. T., Jause M. J., Van Capelle F. J. L, Durrer V.Endocardial mapping by simul taneous recording of endocardial electrograms during cardiac surgery for ventricular aneurysm // J. Amer. Coll. cardiol. - 1983. - Vol. 2. - P. 947-953.

62. Dodge J. T., Brown B. G., Bolson E. L., Dodge H. T.Intrathoracic spatial location of specified

coronary system on the normal human heart // Circulation. - 1988. - Vol. 78, No. 5 (Pt 1).

P.1167-1180.

63. Estes E. H. J., Dalton F. M., Entman M. L. et al. The anatomy and blood supply of the papil lary muscles of the left ventricle // Amer. Heart J. - 1966. - Vol. 71. - P. 356.

64. Favaloro R. G. Surgical treatment of coronary arteriosclerosis. - Baltimore, 1970. - P. 11.

65. Fehn P. A., Howe V. B., Pensinger R. R. Comparative anatomical stenosis of the coronary arteries of canine and parcine heart. II. Interventricular septum // Acta Anat. (Basel). - 1968.

Vol. 7 1 . -P. 223.

66. Freedom R. M., Wilson G., Trusler G. A. et al. Pulmonary atresia and intact ventricular septum // Scand. J. Thorac. Cardiovasc. Surg. - 1983. - Vol. 17. - P. 1-28.

67. Fujita M., McKown D. P., Franklin D. Opening of coronary collaterals by repeated brief coronary occlusions in conscious dogs // Angiology - J. Vase. Dis., 1988. - P. 973-980.

68. Fulton W. F. M. The coronary arteries / Ed. Ch. With Thomas. - Illinois: Springfield, 1963.

69. Geens M., Gonzalez-Lavin L., Dawbarn D., Ross D. N. The surgical anatomy of the pulmonary artery root in relation to the pulmonary valve autograft and surgery of the right ventricular outflow tract // J. Thorac. Cardiovasc. Surg. - 1971. - Vol. 6, No. 2. - P. 262-267.

70. Gensini G. G. Coronary arteriography // Heart disease - A textbook of cardiovascular medicine. 2nd ed. /Ed. E. Braunwald. - W. B. Saunders Co., 1984.

71. Gensini G. G., Buonanno C, Palacio A. Anatomy of the coronary circulation in living man - coronary arteriography // Dis. Chest. - 1967. - Vol. 52. - P. 125-140.

72. Gensini G. G., Esente P. La nomenclature angiografica internazionale della circolarione conarica umena // Giorn. ital. cardiol. - 1975. - Vol. 5, No. 2. - P. 143-198.

73. Gittenberger-de Groot A. C, Sauer U., Oppenheimer-Dekker A., Quaegebeur J. Coronary arteri al anatomy in transposition of the great arteries. A morphological study // Pediat. cardiol.

1983. - Vol. 4 (Suppl. 1.). - P. 15-24.

74. Gray H. Anatomy of the human body, Ed. 25, edited by Charles M. Goss. - Philadelphia: Lea and Febiger, 1948.

75. Gross L. The blood supply to the heart in its anatomical and clinical aspects. - New York: P.B. Hoeber, 1921.

76. Grossman W. G. Anatomy of the coronary arteries // Cardiac catheterization and angiogra phy / Ed. W. G. Grossman, Led and Febinger. - Philadelphia, 1986.

77. Hadziselimovic H., Dilberovic F.,		Blood vessels of the human heart:
Coronarography and dissection //		1980. - Vol. 106, No. 4. - P. 443-449.

78. Harris L., Downar E., Michleborough L. et al. Activation sequence of ventricular tachycardia: Endocardial mapping studies in the human ventricle // J. Amer. Coll. cardiol. - 1987.

Vol. 5 . -P. 1040-1047.

79. Haworth S. G., Macartney F. J. The intrapulmonary arterial circulation in pulmonary atresia with ventricular septal defect and major aorto-pulmonary collateral arteries // Amer. J. Cardiol. (abstr.). - 1979. - Vol. 43. - P. 364.

	Stockley H., Clitsakis D., Layton C. Normal coronary
test? // Brit. Heart J. - 1982. - Vol. 48. - P. 580-583.
	Marchegiani With Le fistole coronariche congenite //	Ann. ital. Chir.

Vol. 4 1 . -P. 977.

82. James T. N. Anatomy of the coronary arteries. - New York: P. B. Hoeber, 1961.

83. James	T. N. Blood supply of the human interventricular septum // Circulation. - 1958.
	1 7 . -P. 391.

84.James	T. N. Burch G. E. The atrial coronary arteries in man // Ibid. - 1958. - Vol. 17.

85. Kiechel F., Blumenthal S., Griffiths S. P. The syndrome of papillary muscle infarction and dysfunction in infants // Congenital cardiac defects - recent advances / Ed. D. Bergsma.

Baltimore, 1972. - Vol. 8, No. 1. - P. 44-50.

86. Kirklin J. W., Bargeron L. M., Pacifico A. D. et al. Management of the tetralogy of Fallot with large aorto-pulmonary collateral arteries // Proceedings of the Fourth Joint Symposium on Congenital Heart disease. - Moscow: Mir, 1981. - P. 24-25.

87. K u gel M. A. Anatomical studies on the coronary arteries and their branches. I. Arteries anastomotica auricularis magna // Amer. Heart J. - 1927. - Vol. 3. - P. 260-270.

88. Kyriakidis M. K., Kourouklis S. V., Papaioannoi J. T. et al. Sinus node coronary arteries stu dies with angiography // Amer. J. Cardiol. - 1983. - Vol. 51. - P. 749.

89. La Porta A., Suy-Verburg R. et al. The spectrum of clinical manifestations of anomalous ori gin of the left coronary artery and surgical management // J. Pediat. Surg. - 1979. - Vol. 14, No. 3. - P. 225-227.

90. Levin D. C. Pathways and functional significance of the coronary collateral circulation // Circulation. - 1974. - Vol. 50.-P. 831-837.

91. Levin D. C, Beckman C F., Garnic J. D. et al. Frequency and clinical significance of failure to visualize the conus artery during coronary arteriography // Ibid. - 1981. - Vol. 63.-P. 833.

92. Levin D. C, Gardiner G. A. Coronary arteriography. In heart disease. - Third edition / Ed. E. Braunwald. - W. B. Saunders Co, Philadelphia, 1988. - P. 268-310.

93. Levin D. C, Harrington D. P., Bettmann M. H. et al. Anatomic variations of the coronary arteries supplying the anterolateral aspect of the left ventricle. Possible explanation for the "unexplained" anterior aneurysm // Invest. Radiol. - 1982. - Vol. 17. - P. 458.

94. Lower R. Tractatus de Corde. - Amsterdam: Elsevier, 1669.

95. MacAlpin R. N., Abbasi A. S., Grollman J. H., Eber L. Human coronary artery size during life. A cinearteriographic study // Radiology. - 1973. - Vol. 108, No. 3. - P. 567-576.

96. Mansaray M., Hynd J. W., Vergroesen J. et al. Measurment of coronary collateral flow and resistance in the presence of an open critical stenoses, and the response to intra-arterial thrombosis // Cardiovasc. Res. - 2000. - Vol. 47, No. 2. - P. 359-366.

	Marcelletti C. Surgery and coronary arteries at	risk // Pediatric Cardiology. 3./eds
	A. E. Becker, T. G. Losekoof, C Marcelletti,	R. H. Anderson. - Edinburgh: Churchill
	Livingstone, 1981. - P. 290-297.
	May A. M. Surgical anatomy of the coronary arteries // Dis. Chest. - 1960. - Vol. 38.

P. 645-657.

99. M with Alpine W. A. Heart and coronary arteries. An anatomical atlas for clinical diagnosis, radiological investigation, and surgical treatment. - Berlin: Heidelberg; New York: Springer-Verlag, 1975.

100. McAlpine W. A. In Heart and coronary arteries. Section II: The normal heart. - Berlin: Heidelberg; New York: Springer, 1975. - P. 20-24.

101. McGoon D. C, Baird D. K., Davis G. D. Surgical management of large bronchial collateral arteries with pulmonary stenosis or atresia // Circulation. - 1975. - Vol. 52. - P. 109.

102. Miller D. C, Schapira J. N., Stinson E. B., Shumway N. E. Left ventricular-coronary sinus fis tula following repeated mitral valve replacement // J. Thorac. Cardiovasc. Surg. - 1978.

Vol. 76, No. 1. - P. 43-45.

103. Moberg A. Anastomoses between extracardiac vessel and the coronary arteries // Acta Med. Scand. - 1968. - Vol. 485 (Suppl.). - P. 5-25.

104. Moran J. M., Michaelis L. L., Sanders J. H., Robert A. J. Separate origin of the first septal branch of left anterior descending coronary artery // J. Cardiovasc. Surg. - 1979. - Vol. 20, No. 6. -P. 621.

105. Nathan H., Orda R., Barkay M. The right bronchial artery. Anatomical considerations and surgical approach. - 1970.

106. Neiman J., Ethevenot G., Guilliere M., Cherrier F. Variations de distribution des arteres coronaries (a propos de 3000 coronarographies) // Bull. Ass. Anat. - 1976. - Vol. 60, no. 176.

P. 769-778.

107. Parker D. L., Pope D. L, Van Bree R. E., Marshall H. Three-dimensional reconstruction of moving arterial beds from digital subtraction angiography // Comput. Biomed. Res. - 1987.

Vol. 20. - P. 166-185.

coronary arteries

stomach and heart. - B. arteries of the stomach(arteriae coronariae ventriculi) depart from the celiac artery (art. coeliaca) or its branches (hepatic artery, splenic, etc.). There are four of them; two of them are connected at the lesser curvature of the stomach and thus form the upper arterial arch of the stomach (arcus arteriosus ventriculi superior); the other two, merging at the greater curvature, form the lower arterial arch of the stomach. A mass of small branches depart from both arterial arches, which enter the wall of the stomach and here break up into the smallest blood stems. B. artery heart (arteria coronaria cordis) - a branch that gives the main vascular trunk of the body (see Aorta), while still in the cavity of the pericardial sac. Starting with two openings lying approximately at the same height as the free edge of the aortic semilunar valves, two V. arteries depart from the expanded part of the latter, called the bulb, and go to the anterior surface of the heart, to its transverse groove. Here, both V. arteries diverge: the right one goes to the right edge of the heart, bends around it, passes to the back surface and along the posterior longitudinal groove reaches the apex of the heart, into the tissue of which it enters; the left first gives a large branch, reaching along the anterior longitudinal groove to the apex of the heart, then goes to the left edge of the heart, passes to the back and here, at the height of the transverse groove, enters the muscles of the heart. Throughout its length, both V. arteries give small branches, penetrating into the thickness of the wall of the heart. The right V. artery supplies blood to the walls of the right atrium, the right ventricle, the apex of the heart, and, in part, the left ventricle; left - apex of the heart, left atrium, left ventricle, ventricular septum. If an animal artificially closes or even only narrows the lumen of the V. artery, then after a while the heart stops contracting (cardiac paralysis), since the heart muscle can work correctly only as long as the V. arteries supply it with sufficient blood necessary for nourishment. quantity. On V. arteries of the human heart, there are pathological changes that affect in a similar way, that is, they completely stop or significantly reduce the flow of blood to the walls of the heart (see Arteriosclerosis, Thrombosis, Embolism) and thereby entail instant death or very painful suffering - myocarditis with its consequences (aneurysm, rupture, heart attack), often angina pectoris, and so on.

encyclopedic Dictionary F. Brockhaus and I.A. Efron. - St. Petersburg: Brockhaus-Efron. 1890-1907 .

See what "Coronary arteries" are in other dictionaries:

Trunk arteries - … Atlas of human anatomy

- (Greek, singular artēría), blood vessels that carry oxygenated (arterial) blood from the heart to all organs and tissues of the body (only the pulmonary artery carries venous blood from the heart to the lungs). * * * ARTERIES ARTERIES (Greek, singular… … encyclopedic Dictionary

Arteries that supply blood to the heart muscle. The right and left coronary arteries (right and left coronary arteries) depart from the bulb and give off branches that supply the heart. See Coronary angioplasty. Bypass vascular shunt. Source:… … medical terms

CORONARY ARTERIES, CORONARY ARTERIES- (coronary arteries) arteries supplying blood to the heart muscle. The right and left coronary arteries (right and left coronary arteries) depart from the bulb and give off branches that supply the heart. See Coronary angioplasty. Bypass shunt ... ... Explanatory Dictionary of Medicine

Vessels of the heart- Arteries. The blood supply to the heart is carried out by two arteries: the right coronary artery, a. coronaria dextra, and the left coronary artery, a. coronaria sinistra, which are the first branches of the aorta. Each of the coronary arteries comes out of ... ... Atlas of human anatomy

HEART- HEART. Contents: I. Comparative anatomy........... 162 II. Anatomy and histology ........... 167 III. Comparative physiology .......... 183 IV. Physiology .................. 188 V. Pathophysiology ................. 207 VI. Physiology, pat. ... ...

ANGINA PECTORIS- Angina pectoris, (angina pectoris, synonymous with Heberden's asthma), in its essence, is primarily a subjective syndrome, manifesting itself in the form of severe retrosternal pain, accompanied by a sense of fear and a sense of the immediate proximity of death. Story. 21… Big Medical Encyclopedia

In the diagram, the Aorta (lat..arteria ortha, a.ortha direct artery [source not specified 356 days]) is the largest unpaired arterial vessel of the great circle ... Wikipedia

LICHTENBERG- Alexander (Alexander Lich tenberg, born in 1880), an outstanding contemporary German. urologist. He was an assistant to Czerny and Narath. In 1924, he received the head of the urological department in the Catholic church of St. Hedwigs in Berlin, to a swarm in ... ... Big Medical Encyclopedia

The science that studies the structure of the body, individual organs, tissues and their relationships in the body. All living things are characterized by four features: growth, metabolism, irritability and the ability to reproduce themselves. The combination of these signs ... ... Collier Encyclopedia