Intercoronary anastomoses in congenital heart disease
C M Bloor1, J F Keefe, M J Browne
1Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA.
Insights
Intercoronary anastomoses in congenital heart disease do not differ in size from controls, but increase with age in operated patients. Surgical trauma is unlikely to be the cause of increased anastomoses.
Area of Science:
- Cardiovascular Research
- Pediatric Cardiology
- Anatomical Studies
Background:
- Intercoronary anastomoses are vital for myocardial blood supply.
- Their role in congenital heart disease (CHD) is not fully understood.
- Normal anastomoses range up to 74 μ in diameter.
Purpose of the Study:
- To investigate the frequency and size of intercoronary anastomoses in patients with CHD.
- To compare anastomoses in CHD patients with control subjects.
- To explore factors influencing anastomoses, such as age, cyanosis, and surgical intervention.
Main Methods:
- Histological examination of 35 hearts from patients with CHD.
- Comparative analysis of intercoronary anastomoses size and frequency.
- Statistical evaluation of findings in relation to clinical data (age, cyanosis, surgical history).
Main Results:
- Anastomoses in non-operated CHD hearts were similar to controls, irrespective of anemia, hypertrophy, or cyanosis.
- Cyanotic patients were significantly younger than acyanotic patients.
- Operated patients showed significantly increased frequency and size of anastomoses.
- Increased anastomoses in operated patients were observed regardless of survival time post-operation (≤48 hours vs. >5 weeks).
- A significant increase in frequency and size of anastomoses was noted in CHD patients over 5 years of age.
Conclusions:
- Intercoronary anastomoses in CHD do not significantly differ from controls in unoperated cases.
- Age is a significant factor, with anastomoses increasing in size and frequency in older CHD patients (>5 years).
- Surgical intervention may influence anastomoses, but the effect is not solely attributable to surgical trauma.
Abstract:
Thirty-five cases of congenital heart disease were investigated for the frequency and size of intercoronary anastomoses. Studies of control hearts showed normal intercoronary anastomoses to range to 74 μ in diameter. In those congenital hearts not subjected to surgical procedures, the anastomoses did not differ in size from the control group, even in the presence of anemia, cardiac hypertrophy, and cyanosis. However, the mean age of the cyanotic group was significantly less than the acyanotic group. Even though the size and frequency of the anastomoses were significantly increased in the operated group, surgical trauma alone was an unlikely stimulus, since the size and frequency of anastomoses in those dying within 48 hours of operation and in those surviving for more than 5 weeks were similar. There was also a significant increase in the frequency and size of the intercoronary anastomoses in cases greater than 5 years of age, implying that intercoronary communications in congenital heart disease increase in size with increasing age.
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