Relationship between orifices of pulmonary and coronary arteries in common arterial trunk
Iki Adachi1, Hideki Uemura, Karen P McCarthy
1Cardiac Morphology Unit, National Heart & Lung Institute, Guy Scadding Building, Imperial College London, Dovehouse Street, London SW3 6LY, UK.
Insights
The sinusal origin of the pulmonary artery, often near coronary arteries, requires careful management. This unique arrangement may simplify surgical connections to the right ventricle.
Area of Science:
- Cardiovascular Anatomy
- Congenital Heart Disease
- Surgical Anatomy
Background:
- Variations in pulmonary and coronary arterial origins in common arterial trunk are known but studied separately.
- Understanding combined anatomical relationships is crucial for clinical implications.
Purpose of the Study:
- To investigate the combined anatomical relationships between pulmonary and coronary arterial origins in the common arterial trunk.
- To determine the clinical significance of these combined relationships.
Main Methods:
- Analysis of 56 heart specimens to identify pulmonary and coronary arterial origins.
- Mapping orifice locations on the common trunk's circumference and distance from the sinutubular junction.
Main Results:
- Pulmonary origins were classified as sinusal (21%), low (20%), or normal (59%).
- Sinusal origins predominantly occurred in the left-anterior segment, while low/normal origins were in the left-posterior segment.
- Sinusal origins showed a significantly higher prevalence of proximity to coronary orifices (75%) compared to low (27%) and normal (3%) origins.
Conclusions:
- The sinusal origin of the pulmonary artery, due to its proximity to coronary arteries, necessitates special attention in diagnosis and surgical planning.
- This anatomical arrangement may offer advantages for direct right ventricular-pulmonary connections, potentially avoiding external conduits.
Objective:
Variability in pulmonary arterial and coronary arterial origins in common arterial trunk has been investigated previously but only as separate entities. We hypothesise that combinations of relationships between the two arterial structures have important clinical implications.
Methods:
We identified pulmonary arterial and coronary arterial origins in 56 heart specimens. The orifices were plotted according to the location on the circumference of the common trunk and distance from the level of the sinutubular junction.
Results:
Pulmonary orifice was sinusal when the lowest margin of the orifice was below the sinutubular junction (n=12, 21%). It was defined as low when located 2mm above the sinutubular junction was designated as normal (n=33, 59%). Circumferentially, there was a distinct predilection for sinusal origin to be located within the left-anterior segment of the common trunk, as opposed to low and normal origins that almost always resided within the left-posterior segment. Furthermore, hearts with sinusal origin (75%; 9 hearts out of 12) had significantly higher prevalence of proximity (defined as a distance of
Conclusions:
Owing to its unique location, frequently close to a coronary orifice, hearts with sinusal origin warrant special attention in both diagnostic and surgical management. At the same time, however, its peculiar pulmonary arrangement may facilitate direct right ventricular-pulmonary connection and dispense with the need for augmentation with an external conduit that inevitably will be outgrown by the patient.
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