Can the location of the large septal artery be predicted?

Abstract

The aim of this study is to establish anatomical landmarks for the trajectory of the large septal artery. Thirty hearts were dissected, 20 of which had no cardiac pathology and the remaining with different cardiac conditions. One large septal artery was located in 27 of these hearts, two large septal arteries in 2 and three large septal arteries in 1. For all cases there existed one large septal artery in the lower border of the anterior limb of the septomarginal trabecula. When more than one large septal artery was encountered, the first was located within the subendocardial outflow tract of the left ventricle, the second was in the lower border of the anterior limb of the septomarginal trabecula and the third 1.5 cm below the second.

The artery of Mouchet: blood supply of the septomarginal trabecula in 50 human hearts

“…A study conducted by Melo et al 28 showed that the human heart possess 7 anterior septal branches on average, although some hearts displayed less than 5 branches, while others possessed 13 branches, in contrast with a study performed by Hosseinpour et al 29 which had the presence of 4 anterior septal branches, on average. In 2% of cases, the ST blood supply originated from an anastomosis between the first anterior septal artery and branches of the right coronary artery.…”

“…Knowledge of the anterior septal branches anatomy is significant to operations such as Ross procedure, Konno procedure (correction of Fallot's tetralogy), resection of obstructive muscular subaortic stenosis, and enlargement of restrictive ventricular septal defects, as they require incisions on the upper portion of the interventricular septum 28,29 . Injury of these vessels can cause myocardial damage and arrhythmia, due to its relation with the ST and right branch of the atrioventricular bundle, in rare cases, iatrogenic injuries can cause sudden death 29 .…”

The structure of the vascular system of the septomarginal trabecula in the heart of an adult

“…Gross was the first researcher to observe the constant occurrence of the artery of the SMT (ramus limbi dextri) in 1921, and other researchers have confirmed its presence. [3][4][5][6][7][8][9][10][11][12] It is often described as a branch of one of the septal arteries, which branches off from the anterior descending artery. While studying the position of the artery of the trabecula, Reig et al noticed that in 20 cases (71%) this artery originated in the 2 nd anterior septal artery, in 5 cases (18%) in the 1 st anterior septal artery, and in 2 cases (7%) in the 3 rd one.…”

“…However, according to Melo et al, this artery is located in the lower part. 4 Reig et al state that the 2 nd path which arteries may follow to the SMT is an oblique path. It extends from the right side of the SMT toward the apex of the heart until it reaches the place where the SMT separates from the septum.…”

“…One major septal artery was found in 90% (27) of hearts, 2 were found in 7% (2) of hearts and 3% (1) of the hearts had 3 arteries, from which 1 would always enter the SMT in its lower part. 4 The knowledge of the topography of the arteries of the SMT, as well as of the paths of the vessels leading to it, is very important for every cardiac surgeon. Procedures can be carried out with a maximum saving rate of the structures of the right ventricle and with the prevention of possible complications (e.g., during the application of a surgical method requiring incisions in the area of the septum, such as the correction of the Tetralogy of Fallot -TOF).…”