CORONARY SYSTEM

CORONARY SYSTEMDr. LITA FERIYAWATI, M.KesDr. DWI RITA ANGGRAINI, M.Kes

DEPARTEMEN ANATOMIFAKULTAS KEDOKTERAN USU

Is the circulation of blood in the blood vessels of the heart muscle (the myocardium). Coronary circulationDEVELOPMENT OF THE CORONARY ARTERY

Circ. Res. 2002;91;761-768Movement of the PEO to and over the heart is shown in the top panel,and mesenchymal migration and differentiation are shown in the bottom panel.The PEO (proepicardial organ) (blue) is seen as an outgrowth from the dorsal body wall that moves to the looping heart (red)Next, migrating epithelium is seen spreading over the heart. In cross section, the epithelium is seen as a single cell layer. Epithelial/mesenchymal transition provides cells that migrate into the myocardium. Vasculogenic cells differentiate and link to form plexi that induce other mesenchymal cells to become smooth muscle. These plexi are remodeled into definitive arteries, and the most proximal points of the major coronarie finally link up with the aorta.NORMAL ANATOMY OF THECORONARY ARTERIESThe coronary arteries are the first branches of the aorta, arising usually from two of the three aortic sinuses of ValsalvaBoth of these arteries originate from the left side of the heart at the beginning (root) of the aorta, immediately above the aortic valve.

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

The right coronary artery originates from the right coronary sinus of Valsalva.The left coronary arteryoriginates from the leftCoronary sinus ofValsalva and after ashort course, bifurcatesinto the anteriorinterventricular artery and circumflex artery

Clinical Anatomy 22:114128 (2009)6

The two sinuses adjacentto the pulmonary trunk give rise to the major coronary arteries, namely the right coronary artery and the main stem of the left coronary artery. On the basis of theseorigins, therefore, the aortic sinuses of Valsalva can be named as the right coronary, left coronary, and noncoronary sinuses, respectivelyClinical Anatomy 22:114128 (2009)The Right Coronary Artery The right coronary artery, which in nine-tenths of individuals supplies most of the diaphragmatic surface of the ventricular mass, emerges from the right coronary aortic sinus in the upper part of the right anterior surface of the aortic root.8

Left Coronary ArteryThe main stem of the left coronary artery usually arises from the left coronary aortic sinus slightly below the sinutubular ridge, Its course is rarely longer than 1 or 2 cm in the adult, after which it divides into the circumflex and anterior interventricular branches.These two arteries, together with the right coronary artery, that make up the three arteries of so-called 3 vessel coronary arterial disease. Left Coronary ArteryThe trunk of the main stem, at between 5 and 10 mm in diameter, is typically much larger than the right coronary artery.Its branches usually supply a larger volume of myocardium, including most of the left ventricle, the muscular ventricular septum, and the supero-lateral papillary muscle of the mitral valve, as well as giving branches to the left atrium, and in just under half the population also supplying the artery to the sinus node

A. coronaria dextra :Ramus nodi sino atrialisRamus marginalisRamus interventricularis posteriorA. coronaria sinistra :Ramus nodi sino atrialRamus interventricularis anteriorRamus circumflexus ramus marginalis

Four percent of people have a third, the posterior coronary artery. In rare cases, a person will have one coronary artery that runs around the root of the aorta.Occasionally, a coronary artery will exist as a double structure (i. e. there are two arteries, parallel to each other, where ordinarily there would be one).VARIATIONS

Clinical Anatomy 22:114128 (2009)If the papillary muscles are not functioning properly mitral valve may leak during contraction of the left ventricle mitral regurgitation. Similarly, the leaking of blood from the right ventricle through the tricuspid valve and into the right atrium can also occur tricuspid insufficiency or tricuspid regurgitation.Blood supply of the papillary musclesBlood supply of the papillary musclesThe anterolateral papillary muscle more frequently receives two blood supplies: left anterior descending (LAD) artery and the left circumflex artery (LCX) more frequently resistant to coronary ischemiaThe posteromedial papillary muscle is usually supplied only by the PDA. significantly more susceptible to ischemia. myocardial infarction involving the PDA is more likely to cause mitral regurgitation.

ANASTOMOSES There is some anastomoses between branches of the two coronary arteries, however the coronary arteries are functionally end arteries. There are three areas of anastomoses:1.Small branches of the LAD (left anterior descending/anterior interventricular) branch of the left coronary join with branches of the posterior interventricular branch of the right coronary in the interventricular groove 2. Anastomosis between the circumflex artery (a branch of the left coronary artery) and the right coronary artery in the atrioventricular groove.3. Anastomoses between the septal branches of the two coronary arteries in the interventricular septum.ANASTOMOSES

CORONARY ARTERY DOMINANCE The artery that supplies the posterior descending artery (PDA) determines the coronary dominanceCORONARY ARTERY DOMINANCEIf the posterior descending artery (PDA) is supplied by the right coronary artery (RCA) "right-dominant". If the posterior descending artery (PDA) is supplied by the circumflex artery (CX) "left-dominant". If the posterior descending artery (PDA) is supplied by both the right coronary artery (RCA) and the circumflex artery "co-dominant".Approximately 70% of the general population are right-dominant, 20% are co-dominant, and 10% are left-dominant

CARDIAC VEINS

CARDIAC VEINS35Terima kasih