Coronary arteries and veins DR NIKUNJ .R .SHRKHADA (MBBS,MS GEN SURG DNB CTS SR)

1. ANATOMY OF CORONARY
ARTERIES AND VEINS
BY DR NIKUNJ
(CTS RESIDENT STAR HOSPITAL)
(Coordinator:DR P.SATYENDRANATH PATHURI)
(18/6/18)

2. • The coronary circulation is
composed of the coronary
Arteries and veins together
with the lymphatics of the
heart.
• The coronary arteries are the
first branches of the ascending
portion of the aorta, arising
from the aortic root
immediately above its
attachment to the heart.
• Normally, there are three
sinuses at the aortic root The
sinuses can be named, right
coronary, left coronary, and
noncoronary sinus

3. Right coronary artery
• The right coronary artery emerges from the right-
handfacing aortic sinus and immediately enters the
right atrioventricular groove
• Immediately after its origin, the artery gives rise to
downgoing infundibular branches, one of which may
also arise by a separate orifice
• AV sulcus :Right Ant Ventricular A
• Right Ant Atrial A - SA NODAL A
• At acute marginal A upto the apex of heart.
• RCA asit crosses the crux where it takes deep U turn
and givingoff AV node A at the apex of turn.
• RCA then terminates by biforcating in to the PDA &
PLVB

5. • Angiographic segments
of RCA
• PROXIMAL RCA: Above sa nodal branch
• MID RCA : sa nodal branch till acute
marginal branch
• DISTAL RCA: beyond acute marginal
branch

7. Left coronary artery
• LEFT MAIN CORONARY A
• The main stem of the left coronary artery emerges from
the left-hand-facing sinus between the pulmonary trunk
and the left atrial appendage. It is a short structure,
rarely extending beyond 1 cm before branching
• In some hearts, the main stem trifurcates, with an
intermediate branch present between the two main
branches
• LEFT ANTERIR DESCENDING A
• LAD runs within the anterior interventricular groove,
giving off diagonal branches to the obtuse margin, and
the important perforating branches that pass inferiorly
into the septum
• The interventricular artery then continues toward the
apex, and it frequently curves under the apex onto the
diaphragmatic surface of the ventricles.
• LOOP OF VIEUSSENS

9. • The circumflex branch of the left coronary
artery
• Originates from lmca at 90’ angle.
• SA NODA A some time originates from first few
cm
• passes backward to run in relationship with the
mitral orifice
• Large branch originating from lcx continue
around the LV in a AV groov termed as atrial
circumflex A
• Ventricular branch of lcx is Obtuse marginal A

10. •Type I : ends above the cardiac apex.
•Type II :ends at cardiac apex.
•Type III: ends beyond cardiac apex.
Angiographic segments of LAD
•PROXIMAL LAD: from LT coronary
ostium to first major septal or diagonal
•MID LAD :from first major septal or
diagonal to second diagonal
•DISTAL LAD :beyond second diagonal
LAD

11. THE SINUS NODE A
•Single 89% double11%
•RCA :55-65% LCA:55-45%

13. AV NODE A
•As RCA crosses the crux where it takes
deep U turn and givingoff AV node A at the
apex of turn.
•AV node supplied by dominant coronary A.
•KUGAL’S A.

14. VENTRICULAR SEPTUM
•ANT : LAD.
•POST: PDA. (small portion)

15. • 1. Great Cardiac vein
• Begins near apex of heart; acc. LAD& more
proximally cx artery
• Terminates at lt end of coronary sinus
• 2. Middle cardiac vein
• •Accompanies PDA and opens at termination
of coronary sinus
• 3. Small Cardiac vein
• Accompanies rt marginal artery Runs in AV
groove to end into rt end of CS May open
directly into rt atrium
• 4. Oblique Vein of Lt Atrium
Runs in the post surface of Lt Atrium and drains
into Lt end of Coronary sinus
• 5. Post Vein of Lt Ventricle
• Runs on diaphragmatic surface of Lt ventricle
and ends in middle of coronarysinus
• 6. Rt Marginal vein
• Accompanies Rt Marginal artery and drains
into Small Cardiac vein or directly into the Rt
Atrium
• Valves are also found in the cardiac veins.
That found in the great cardiac vein where it
turns around the pulmonary surface is most
constant and is called the valve of Vieussens

16. THANK YOU