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Cardiac & Cerebral Vascular Anatomy

Coronary Vasculature

"Coronary Arteries in 3D"
  • Coronary artery in 3D from 3D vascular atlas image using volume rendering techniques (3D CT):  courtesy of Elliot Fishman, MD,(c) 2000, Department of Radiology, Johns Hopkins University, used with permission.

  • Circumflex branch

    •  Follows atrioventricular groove

    •  One branch: obtuse marginal

    •  Perfuses

      • All the posterior left ventricular

      • Part of the right ventricular wall

    •  Electrocardiographic changes associate with circumflex coronary artery disease observed in: leads I & aVL

  • Sinus node & atrioventricular (AV node) nodal arteries: originates from the right coronary artery

  • Sinus nodal artery: supplies the right atrial myocardium.

  • Blood supply to the AV node & Bundle of His: 

    1. Right coronary artery atrioventricular branch  (90% of hearts)

    2. Septal perforating branches of the left anterior descending vessel (10% of hearts) are

  • Blood supply to the right bundle branch:

    • Branches of the left anterior descending coronary vessel

  •  Electrocardiographic changes associated with right coronary artery occlusion:

    • ECG changes in leads II, III, and aVF

    • Aberrant conduction

     

  •   Coronary Artery Perfusion Patterns

    • Left Coronary Artery

      • Anterolateral left ventricle

      • Anterior descending branch

      • Right bundle branch

      • Left bundle branch

      • Anterior and posterior papillary muscles (mitral)

    • Right Coronary Artery

      • Sinoatrial (SA) and Atrioventricular (AV) nodes

      • Right atrium and ventricle

      • Posterior interventricular septum

      • Posterial fascicle of left bundle branch (LBB)

      • Interatrial septrum

    • Circumflex Artery Branch

      • Lateral left ventricle

  • Cerebral Circulation: Components

    • Circle of Willis

      1. Anterior communicating arteries

      2. Internal carotid arteries

      3. Posterior communicating arteries

      4. Vertebral arteries

        1. Circle of Willis

 

    1. Internal carotid artery

    2. Horizontal (A1) segment of anterior cerebral artery (ACA)

    3. Anterior communicating artery (ACOM)

    4. Posterior communicating artery (PCOM)

    5. P1 segment of posterior cerebral artery

    6. Basilar artery bifurcation

    7. Middle cerebral artery (MCA)

    8. Vertebral arteries

    image: William G. Staten, R.T. (R) (ARRT), copyright November 1996

     

  • External carotid supply:

    • Face

    • Neck (not brain)

  •  Clinical Note:

    • During carotid artery surgery, a pressure transducer inserted into the internal carotid artery {during clamping of external & common carotid arteries} allow measurement of arterial pressure occurring as a result the blood flow through the circle of Willis

  • Bronchial Circulation
    • Origination of bronchial arteries: from the thoracic aorta at T5 &  T6 or intercostal arteries

    • Three bronchial arteries (to for the left lung; one for the right lung)

    • Clinical factors which may change bronchial circulation

      •  Inadequate pulmonary flow -- e.g. in congenital heart disease-- causes an increase in blood flow

      •  Tumor (increase flow)

      •  Injury (increase flow)

 
 
 
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  • Primary Reference: Lake, C.L. Cardiovascular Anatomy and Physiology, Third edition  (Barash, PG, Cullen, BF, Stoelting, R.K, eds), Lippincott-Raven Publishers, Philadelphia, pp. 805-835, 1997
  • Primary Reference:  Ross, AF, Gomez, MN. and Tinker, JH Anesthesia for Adult Cardiac Procedures in  Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 1659-1698, 1998.
  • Primary Reference: Shanewise, JS and Hug, Jr., CC, Anesthesia for Adult Cardiac Surgery, in Anesthesia, 5th edition,vol 2, (Miller, R.D, editor; consulting editors, Cucchiara, RF, Miller, Jr.,ED, Reves, JG, Roizen, MF and Savarese, JJ) Churchill Livingston, a Division of Harcourt Brace & Company, Philadelphia, pp. 1753-1799, 2000.
  • Primary Reference: Wray Roth, DL, Rothstein, P and Thomas, SJ Anesthesia for Cardiac Surgery, in Clinical Anesthesia, third edition  (Barash, PG, Cullen, BF, Stoelting, R.K, eds), Lippincott-Raven Publishers, Philadelphia, pp. 835-865, 1997