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Pathological morphology and clinical significance of the anomalous origin of the left circumflex coronary artery from the right coronary artery general review and an autopsy analysis of 30 cases


Pathological morphology and clinical significance of the anomalous origin of the left circumflex coronary artery from the right coronary artery general review and an autopsy analysis of 30 cases



Glas Srpska Akademija Nauka i Umetnosti Odeljenje Meditsinskikh Nauka 358(39): 77-102



After an extensive analysis of the world literature (121 references), beginning from the first reported case by Antopol and Kugel, 1933 [2], the general review of the problem stressed especially the following morphologic characteristics and clinical significance of the anomalous origin of the left circumflex coronary artery (LCxA) from the right coronary artery (RCA): The place of the anomalous origin of LCxA from RCA among all other variations and anomalies of LCxA. The anatomical and topographical characteristics of LCxA originating from RCA in normal heart as well as in congenital heart diseases-CHD (especially complete transposition of great arteries -TGA). The formal genesis of LCxA from RCA according to original new Ogden's theory (1968. [74] and 1969. [72]), taking into account the dual origin of the coronary arteries and the peritruncal angioblastic ring that surrounds the developing aorta and pulmonary artery. The frequencies of the origin of LCxA from RCA in autopsy and coronarography series. The importance of LCxA (by its origin and/or caliber) in determination of the right, left or codominance of the coronary arteries including the pecularities in cases of isolated aortic stenosis and bicuspid aortic valve. The importance of recognizing LCxA from the RCA during implantation of artificial aortic, mitral and tricuspid heart valves, during mitral valve anuloplasty, closure of ostium primum defect as well as during aorto-coronary venous bypass. The LCxA from RCA, especially its proximal segment, shows more frequent and an earlier, faster and heavier obstructive atherosclerosis, causing different manifestations of coronary heart disease and sudden death. Also, mitral insufficiency can be caused by ischemia of the papillary muscles of the left ventricle. The awareness of the possibility that LCxA may arise from the RCA can prevent many complications during cannulations of the coronary arteries for diagnostic coronarography and myocardial perfusion during heart operations. The authors presented their 30 autopsied cases of LCxA from RCA, analysing morphological and topographic data as well as their clinical significance and association with other CHD. There were 6 isolated cases and 24 cases associated with other CHD (20 with TGA and 4 with other CHD). Our first autopsied case of LCxA from RCA was diagnosed as associated with tetralogy of Fallot in 1964. During the period 1964-1985 we had 1015 cases of CHD (including 132 cases of TGA).

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Related references

Pathologic morphology and clinical significance of the anomalous origin of the left circumflex coronary artery from the right coronary artery. General review and autopsy analysis of 30 cases. Glas. Srpska Akademija Nauka i Umetnosti. Odeljenje Medicinskih Nauka 1990(39): 77-103, 1990

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