The Extracardiac Anastomoses of the Coronary Arteries

Abstract

In a series of experiments planned for the purpose of injecting the vessels in the heart valves, a colloidal suspension of carbon particles was injected into the coronary arteries of human hearts which had been excised at autopsy. When one came to study the injected specimens it was soon observed not only that the vessels in the heart were filled with the carbon particles but also that the arteries in attached flaps of the parietal pericardium contained the injection mass. Further observation showed that an extensive network of vessels in the adventitia of the aorta and pulmonary artery was also injected.These observations led to a more thorough study of theextracardiac anastomoses of the coronary arteries. The results of this investigation are reported here.The literature furnishes little if any detailed description of the extracardiac anastomoses of the coronary arteries. The most instructive paper is that of I~nger (4) who, during a study of the Thebesian vessels by coronary artery injection, described branches of the coronary arteries anastomosing with vessels in the mediastinum, the parietal pericardium, the diaphragm and the hila of the lungs. Woodruff (10) in 1926 called attention to anastomoses of branches of the coronary arteries with the vasa vasorum of the ascending aorta. In 1928 Wearn (9) noted that on injecting the coronary arteries with India ink or Berlin blue the vessels in the ascending aorta were filled with the injection mass. Robertson (6) in 1930 pointed out the importance of the arteries of the fat pads of the heart in the presence of disease of the coronary arteries. He discussed also the anastomoses of branches of the coronary arteries with the periadventitial vessels of the ascending aorta and other vessels of the thorax. Several reviews of the literature including those

Function of Natural Internal Mammary–to–Coronary Artery Bypasses and Its Effect on Myocardial Ischemia

“…The anatomy of extracardiac coronary arterial anastomoses taking their origin from the bronchial or the internal thoracic arteries was alluded to as early as . Hudson et al 10 rediscovered them accidentally by observing the supply of ink injected into the coronary circulation to the pericardium and to extracardiac arterial regions. Hence, communication between the coronary circulation and pericardiacophrenic branches of the IMAs, but also the anterior mediastinal, phrenic, and intercostal arteries and the esophageal arterial branches of the aorta, was demonstrated.…”

“…10,11 In the advent of coronary bypass surgery, bilateral IMA ligation in patients with CAD has been suggested to alleviate angina pectoris and ECG signs of ischemia, [12][13][14][15][16] although this finding has been challenged by 2 very small sham-controlled trials. 17,18 Using angiographic techniques, a total of 3 case reports have described the structural existence of in vivo naturally occurring anastomoses between one of the IMAs and the coronary circulation.…”

The porcine bronchial artery. Anastomoses with oesophageal, coronary and intercostal arteries

“…The existence of bronchial-coronary anastomoses has been reported in man (Petelenz, 1965 ;Bjørk, 1966 ;Moberg, 1967) and in pigs (White et al 1992). Bronchial-oesophageal arterial anastomoses and intercostobronchial arteries are also found in man (Hudson et al 1932 ;Cauldwell et al 1948 ;Kasai & Chiba, 1979 ;Nørgaard et al 1997), and in cattle (Calka, 1969), but we found no reports of such anastomoses in pigs or other species. If physiological or other functional investigations of the bronchial artery are to be undertaken, account must be taken of the collateral sources mentioned above.…”

“…As far as the lungs and the bronchi are concerned, the reverse contribution is also of interest. To our knowledge, the contribution to the porcine bronchial circulation from other mediastinal sources, such as anastomoses between arterial bronchial branches and direct aortic oesophageal arteries, which have been described in man (Hudson et al 1932 ;Cauldwell et al 1948), has not been investigated previously. Thus an important prerequisite has been missing for experimental studies of the porcine bronchial circulation.…”

Coronary vasodilatation following diazepam (Valium)

“…Aortic and right atrial pressures were measured through indwelling catheters connected to Statham P23Db pressure transducers. The bronchial arteries were ligated to exclude extracoronary myocardial blood flow (Hudson, Moritz & Wearn, 1932). The main pulmonary artery was ligated to ensure collection of all coronary blood returning to the right side of the heart.…”