RBCCV Brazilian Journal of Cardiovascular Surgery Revista Brasileira de Cirurgia Cardiovascular

ISSN (on-line): 1678-9741
ISSN (Print): 0102-7638 Impact Factor: 0.963 Prof. Zerbini - 100 anos

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Volume 26 Number 2, April - June, 2011

ORIGINAL ARTICLE

DOI: http://dx.doi.org/10.1590/S0102-76382011000200013

Anatomia da artéria coronária direita: análises anatômicas e morfométricas

Right coronary artery anatomy: anatomical and morphometric analysis

Luis Ernesto Ballesteros⁰; Luis Miguel Ramirez⁰; Ivan Dario Quintero⁰

Work carried ou atUniversidad Industrial de Santander, Bucaramanga, Colombia - Universidad de Antioquia, Medellin, Colombia.

Correspondence To:
Luis Ernesto Ballesteros
Av. Gonzales Valencia, 54-25 - Apto 404
Bucaramanga, Colombia
E-mail: lballest56@yahoo.es

RESUMO

INTRODUÇÃO: É necessário conhecer a grande variabilidade da artéria coronária direita (ACD), especialmente por suas implicações nos procedimentos cirúrgicos e eventos clínicos. Esta variabilidade está geralmente relacionada à extensão, à quantidade de ramos, à origem e aos territórios irrigados.
OBJETIVO: Avaliar por exame direto a expressão morfológica da ACD em sujeitos colombianos.
Métodos: As ACD foram medidas em 221 corações frescos pela canalização do óstio da ACD com uma resina de poliéster sintético que foi injetada em seus ramos.
RESULTADOS: O calibre do segmento proximal da ACD e ao nível do ângulo agudo do coração foi de 3,42 ± 0,66 mm e 2,9 ± 0,50 mm, respectivamente. A ACD terminou entre a crux cordis e a margem esquerda em 75,6% da amostra. A artéria interventricular posterior (AIP) atingiu o terço inferior, o ápice ou o sulco interventricular anterior em 149 (67,4%) casos. A artéria do nó sinoatrial (ANS) surgiu da artéria coronária direita em 134 (60,6%) casos, 77 (34,9%) da artéria circunflexa (ACx) e de ambas em 10 (4,5%) amostras. A artéria diagonal posterior direita (ADPD) foi observada em 38 (17,2%) corações, mas apenas 6% da amostra com uma AIP longa, apresentaram a ADPD (P=0,001). Em corações com dominância direita, a ANS surgiu da ACD em 54,7% e da ACx em 46,3% dos casos (P=0,06).
CONCLUSÕES: O calibre da ACD e seus ramos é menor do que o relatado na maioria de estudos anteriores, enquanto que a frequência da ADPD é ligeiramente superior ao relatado na literatura. Cenários clínicos e patológicos por estas variações devem ser levados em conta: procedimentos de hemodinâmica, cirurgia cardíaca e arritmias de doença coronária obstrutiva.

Keywords Vasos coronários. Circulação coronária. Nó Atrioventricular. Nó Sinoatrial.

ABSTRACT

BACKGROUND: It is necessary knowing the large variability of right coronary (RCA) artery specialty for its implications in surgical procedures and clinic events. This variability is usually related to the length, branches quantity, origin and irrigated territories.
OBJECTIVE: To evaluate by direct examination the morphologic expression of RCA in Colombian people.
METHODS: RCA were measured in 221 fresh hearts by RCA ostium canalization with polyester synthetic resin that was injected in their branches.
RESULTS: The caliber of the RCA proximal segment and at the level of the acute angle of the heart was 3.42 ± 0.66 mm and 2.9 ± 0.50 mm, respectively. It ended between crux cordis and the left margin in 75.6% of specimens. Posterior interventricular artery (PIA) reached the inferior third, or the apex, or the anterior interventricular sulcus in 149 (67.4%) cases. Sinoatrial node artery (SNA) originated in the right coronary in 134 (60.6%) cases, 77 (34.9%) from circumflex artery (CxA) and from both in 10 (4.5%). Posterior right diagonal artery (PRDA) was noted in 38 (17.2%) hearts, but only 6% of the sample with long PIA, concomitantly presented the PRDA (P = 0.001). In right dominance SNA were originated from RCA in 54.7% and form CxA in 46.3% (P = 0.06).
CONCLUSIONS: Caliber of the RCA and its branches is lesser than the majority of previous studies, while the PRDA frequency is slightly higher than the reported in literature. Clinical and pathological scenarios by these variations should be taken into account: hemodynamic procedures, cardiac surgery and arrhythmias from coronary occlusive disease.

Palavras-Chave Coronary vessels. Coronary circulation. Atrioventricular Node. Sinoatrial node.

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