PKA vessels. Collateral blood circulation of coronary arteries

Coronary blood circulation ensures blood circulation in myocardium. By coronary arteries, blood enriched with oxygen comes to heart according to a complex circulation scheme, and the outflow of deoxygenated venous blood from myocardium passes through the so-called coronary veins. There are surface and small deeply arranged arteries. On myocardial surfaces are epicardial vesselsFor which the characteristic difference is self-regulation, which allows to maintain the optimal blood supply to the organ required for normal performance. Epicardial arterys differ in a small diameter, which often leads to atherosclerotic damage and narrowing the walls with the subsequent occurrence of coronary failure.

According to the diagram of the blood vessels, two main trunks of coronary vessels are distinguished:

• right coronary artery - comes from the right aortic sinus, is responsible for the bloodstream of the right and rear-bottom wall of the left ventricles and some part of the interventricular partition;
• left - comes from the left aortic sinus, then it is divided into 2-3 small arteries (less often four); The most significant are considered front downward (front interventricular) and envelope branches.

In each individual case, the anatomical structure of the heart vessels may vary, therefore, for a full study, the cardiography of the heart vessels (coronary art) is shown using an iodine-containing contrast agent.

Main branches right coronary artery: The branch of the sinus knot, the cone branch, the right-hand branch, the branch of the sharp edge, the rear interventricular artery and the rear-side artery.

Left coronary artery begins a trunk, which is divided into the front interventricular and envelope arteries. Sometimes between them leaves intermediate artery (a.interMedia). Front interventricular artery (front descending) gives diagonal and septal branches. Basic branches envelope artery are branches of stupid edge.

Miocardial blood circulation varieties

Based on the bloodstand of the rear wall of the heart distinguish the balanced, left and right type of blood circulation. The definition of the predominant type depends on whether one of the arteries of the immudidial section reaches, which was formed as a result of the intersection of two furrows - theft and intergventhroke. One of the arteries reaching this area gives the branching passing towards the tip of the organ.

Consequently prevailing right type of blood circulation The authority is ensured by the right artery having a structure in the form of a large trunk, while the envelope of the artery to this area is poorly developed.

Predominance left type Accordingly, it assumes the preemptive development of the left artery that envelopes the root of the heart and ensuring the blood flow of the organ. In this case, the diameter of the right artery is small enough, and the vessel itself comes only to the middle of the right ventricle.

Balanced type It assumes a uniform blood flow to the above-mentioned portion of the heart on both arteries.

Atherosclerotic lesion of heart vessels

Atherosclerotic heart disease and vessels are a dangerous damage to the vascular walls, characterized by the formation of cholesterol plaques, which become the cause of stenosis and impede the normal flow of oxygen and nutrients to the heart. The symptoms of atherosclerosis of the heart vessels are more often manifested in the form of angina attacks, lead to myocardial infarction, cardiosclerosis, as well as the thinning of the vascular walls, which threatens them with a gap and without timely treatment leads to disability or lethal exodus.

How is IBS manifest?

The main cause of the development of IBS are atherosclerotic deposits on vascular walls. Other reasons for circulatory disorders are to:

• improper nutrition (the predominance of animal fats, fried and fatty dishes);
• age changes;
• men are several times more likely to suffer from vascular diseases;
• diabetes;
• excess weight;
• genetic predisposition;
• persistent increase of blood pressure;
• the disturbed ratio of lipids in the blood (leaf-like substances);
• harmful habits (smoking, drinking alcoholic beverages and narcotic substances);
• sedentary lifestyle.

Diagnosis of blood vessels

The most informative method, how to check the heart vessels is angiography. For the study of the coronary arteries is applied selective coronary photography of heart vessels - A procedure that allows us to estimate the state of the vascular system and determine the need for surgery, but has contraindications and in rare cases leads to negative consequences.

During the diagnostic study, a patch puncture is performed through which the catheter is introduced to the vessels of the heart muscle to supply a contrast agent, as a result of which an image is displayed on the monitor. Next, the section of the narrowing of the walls of the artery is revealed and its degree is calculated. This allows the specialist to predict the further development of the disease.

In Moscow, the price of the coronary art of the heart vessels on average range from 20,000 to 50,000 rubles, for example, the Center for Cardiovascular Surgery Bakulev provides the services of a qualitative study of coronary vessels, the cost of the procedure starts from 30,000 rubles.

General methods for the treatment of heart vessels

For treating and strengthening vessels, integrated methods consisting of adjusting nutrition and lifestyle, drug therapy and surgical intervention are used.

• compliance with diet food, with increased use of fresh vegetables, fruits and berries, which is useful for strengthening the heart and vessels;
• light gymnastic exercises are prescribed for heart and vessels at home, we recommend swimming, jogging and daily walks in the fresh air;
• the complexes of vitamins for the vessels of the brain and heart with an elevated content of retinol, ascorbic acid, tocopherol and thiamine are prescribed;
• droppers are used to maintain heart and vessels that feed and restore the structure of tissues and walls in the minimum time;
• medications are used for heart and vessels that reduce the painful sensations, output cholesterol, reduced blood pressure;
• a new methodology for improving the activities of the heart and vessels is listening to therapeutic music: American scientists have proven a positive effect on the contractile function of myocardium while listening to classical and instrumental music;
• good results are observed after the use of traditional medicine: some medicinal plants have a strengthening and vitamin action for the heart and blood vessels, which are most popular with a decoction of hawthorn and dyeing.

Surgical methods of heart vessels

X-ray thrown at work, performing angioplasty and heart stenting

To improve the blood circulation of the coronary arteries, balloon angioplasty is carried out and stenting.

The method of balloon angioplasty implies the introduction of a specialized tool into the affected artery to inflate the walls of the vessel in the area of \u200b\u200bnarrowing. The effect after the procedure is preserved temporarily, since the operation does not imply eliminate the main cause of the stenosis.

For the most efficient treatment of the stenosis of vascular walls, the installation of stents in the heart vessels is carried out. The specialized frame is introduced into the affected area and expands the narrowed walls of the vessel, respectively improves myocardial blood supply. According to the reviews of leading cardiac surgeons, after stenting the blood vessels of the heart, life expectancy increases if all medical recommendations are fulfilled.

The average cost of stenting the blood vessels in Moscow ranges from 25,000 to 55,000 rubles, without taking into account the cost of instruments; Prices depend on many factors: the severity of pathology, the number of required stents and cylinders, the rehabilitation period, and so on.

The main source of blood supply to the heart is the coronary artery (Fig. 29). Artery hearts - aa. Coronariae Dextra Et Sinistra, Crown Arteries, Right and Left, start from Bulbus Aortae below the upper edges of the semi-lunged valves. Therefore, during systole, the entrance to the coronary artery is covered with valves, and the arteries themselves are compressed by the abbreviated heart muscle. As a result, during the systole, the blood supply to the heart decreases: the blood in the coronary artery arrives during the diastole, when the inlet holes of these arteries, which are in the mouth of the aorta, are not closed by semi-short valves. Right Crown Artery, a. Coronaria Dextra, comes out of the aorta, respectively, the right semi-lounge flap and falls between the aorta and the ear of the right atrium, the duck from which she envelopes the right edge of the heart along the corrosion and turns onto its back surface. Here it continues to the interventricular branch, Interventricularis Posterior. The latter descends over the rear interventricular furrow to the top of the heart, where he anastomoses with the branch of the left cornoe artery. The branches of the right-wing artery vascuarize: the right atrium, a part of the front wall and the entire back wall of the right ventricle, a small portion of the back wall of the left ventricle, the interpidential partition, the back of the interventricular partition, the puffy muscles of the right ventricle and the rear puffy muscle of the left ventricle. Left cornese artery, a. Coronaria Sinistra, coming out of the aorta in the left half-lift damper, also falls into the corner of the Kepened from the left atrium. Between the pulmonary barrel and the left ear, it gives two branches: a thinner front, interventricular, Ramus Interventricularis Anterior, and a larger left, envelope, Ramus Circumflexus. The first is descended by the front interventricular furrow to the top of the heart, where it anastomoses with the branch of the right corner artery. The second, continuing the main trunk of the left corrosive artery, envelopes on the corner of the head of the head on the left side and also connects to the right corveric artery. As a result, an arterial ring, located in a horizontal plane, is formed in the horizontal plane, from which perpendicular to heart branches. The ring is a functional device for the collateral blood circulation of the heart. The branches of the left cornese artery vascuate the left, atrium, the entire front wall and most of the back wall of the left ventricle, part of the front wall of the right ventricle, the front 2/3 of the interventricular partition and the front papillary muscle of the left ventricle.

There are various variants of the development of crown arteries, as a result of which there are different ratios of blood supply pools. From this point of view, there are three forms of blood supply to the heart: uniform with the same development of both corpical arteries, left-hand and legal. In addition to the crown arteries, the "additional" arteries are suitable for the heart from the bronchial arteries, from the lower surface of the aorta arc near the arterial ligament, which is important to take into account not to damage them during operations on the lungs and the esophagus and this does not worsen the blood supply to the heart.

Intoral heart artery: from the trunks of the corn-free artery and their large branches, respectively, 4 heart cameras and their ears (RR. Auriculares), branches of the ventricles (RR. Ventriculares), partition branches (RR. Septales Anteriores et Posteriores ). Penetrating myocardial in the thickness, they branched out the number, location and device of the layers of it: first in the outer layer, then on average (in ventricles) and, finally, in the internal, after which they penetrate into the puffy muscles (AA. Papillares) and even in the atrough -Hellic valves. The intramuscular arteries in each layer follow the course of muscle beams and anastomed in all layers and hearts. Some of these arteries have a highly developed layer of involuntary muscles in their wall, with a reduction in which a complete closure of the vessel lumen occurs, why these arteries are called "closing". The temporary spasm of the "closing" arteries can entail the cessation of blood current to this section of the heart muscle and cause myocardial infarction

Fig. 29.

By 15-18 years, the diameter of the coronary arteries is approaching adult indicators. At the age of 75, some increase in the diameter of these arteries is observed, which is associated with the loss of the elastic properties of the arterial wall. Most people have the diameter of the left cornen artery more right. The number of arteries derived from the aorta to the heart can decrease to 1 or increase to 4 due to additional coronary arteries, which are not normal. Left coronary artery (LKA) originates in the assholes of the Bulb of Aorta, passes between the left atrium and la and about 10-20 mm shared on the front interventricular and envelope branches. The front interventricular branch is a direct continuation of the LKA and passes in the corresponding head of the heart. Diagonal branches are deployed from the front interventricular branch of the LCA (from 1 to 4), which are involved in the blood supply to the side wall of the LV and can anatomize with the envelope branch of the LV. LKA gives from 6 to 10 partition branches, which blood supply to the front two thirds of the interventricular partition. The front interventricular branch itself reaches the top of the heart, providing it with blood. Sometimes the front interventricular branch passes to the diaphragmal surface of the heart, anathematizing with the rear interventricular artery artery, carrying out collateral blood flow between the left and right coronary arteries (with the right or balanced type of blood supply to the heart). The right edge branch used to be called the artery of the sharp edge of the heart - Ramus Margo Acutus Cordis. The left edge branch is the branch of the stupid edge of the heart - Ramus Margo Obtusus Cordis, as a well-developed myocardium of the hearts makes its edge rounded, stupid). Thus, the front interventricular branch of the LKA is blood supply to the front-winding wall of the LV, its top, most of the interventricular partition, as well as the front papillary muscle (due to the diagonal artery). The envelope branch, departing from the LKA, located in AV (Vernoe) -Bozde, goeshes the heart to the left, reaches the intersection and the rear interventricular furrow. The envelope branch can end with the stupid edge of the heart, and continue in the rear interventricular furrow. Passing in ancient furrow, the envelope branch sends large branches to the side and rear walls of LV. In addition, important atrial arteries depart from the envelope of the branch (among them - Nodi Sinoatralis). These artery, especially the artery of the sinus node, are abundantly anastomized with the branches of the right coronary artery (PKA). Therefore, the branch of the sinus node has a "strategic" value in the development of atherosclerosis in one of the main arteries. PKA begins in the direction of the Aorta Bulbs Sinus. Returning from the front surface of the aorta, the PKA is located in the right-hand side of the cornerwall, comes to the acute edge of the heart, envelopes it and goes to SSH and further to the rear interventricular furrow. In the area of \u200b\u200bintersection of the rear interventricular and coronary, PKA gives the rear interventricular branch, which goes towards the distal part of the front interventricular branch, anatomying with it. Rarely PKA ends at the sharp edge of the heart. The PKA with its branches is blood supply to the right atrium, a part of the front and the entire back surface of the LV, the interpidential partition and the back of the interventricular partition. From the important branches of the PKA, it should be noted the branch of the cone of the pulmonary trunk, the branch of the sinus node, the branch of the right edge of the heart, the rear interventricular branch. The branch of the mole branch cone often anastomoses with a conical branch, which departs from the front interventricular branch, forming the Ring of Visane.

PKA - Right coronary artery (PVA - Right Crown Artery).
Right Coronary Artery (RCA), Right Main Coronary Arttery.

The right coronary artery is departed from the right aortic (1-ter face) sinus, most often in the form of a trunk, which goes on the right atrioventricular furrow, enveling a three-rolled valve, and a guide heart.

The RCA TYPICALLY Arises from the Right Sinus of Valsalva (RSV) of the Ascending Aorta, Passes Anteriorly and To the Right Between The Right Auricle And The Pulmonary Artery And Then Descends Vertically In The Right Atrioventricular Sulcus. When the Heart The Heart, It Turns to Continue Posteriorly In The Surface and Base of the Heart.

A single-layer anatomical scheme of the structure of the valvety-arterial tree and the heart complex. A is the system of the left cornese artery (LVA), b: the system of the right-wing artery (PVA).
1 - the first face of the aorta, 2 - the second facial sine of aorta. Aorta, la - pulmonary artery, UPP - Ushko right atrium, ULP - left atrium ushko, PMF - front interventricular branch, oh - envelope branch, DV - diagonal branch, VTK - branch of stupid edge, ACS - artery of a sinus knot, ka - cone artery, Bok - the branch of the acute edge, A.Avu - the artery of an atrioventricular node, ZMZHV - rear interventricular branch.
A source: Beria L. A., Berishvili I. I. Surgical anatomy of the coronary arteries. M.: Publishing house NCSSH them. A.N. Bakuleva Ramna, 2003.

Ka - cone artery (branch of arterial cone).
Conus Branch, Infundibular Branch, Conus Arteriosus Branch.

Cone artery is the first large branch of the right coronary artery, but can be deducted by an independent mouth from the 1st facial aorta sinus. Cone artery supplies the arterial cone (Conus Arteriosus) and the front wall of the right ventricle and can participate in the blood supply to the front interventricular partition.

The ARTERY HAS A VARIABLE DISTRIBUTION, BUT USALY SUPPLIES A REGION OF THE ANTERIOR INTERVENTRICULAR SEPTUM AND THE CONUS OF THE MAIN PULMONARY ARTERY (Hence Its Name). Although An Acute Occlusion of the Tiny Arttery Has Been Shown to Result In S-T Elevation, Another More Important Role IT Serves In Pathophysiology Is That Of A Route of Collateral Circulation. The Conus Arttery Has Been Shown to Colladeralise with the more distal acute Marginal Branch in Rca Stenosis / Observation, and Collading Artery (LAD) in Lad Stenosis / Observation, Providing a Pottentially Vital Collateral Pathway.

ACS is an artery of a sinus assembly (branch of a sinus unit, an artery of a sinus-atrial node (A.Spu), a branch of a sinus-atrial node).
SinoATRIAL NODAL ARTERY (SANA), SINUS NODE ARTERY, SINOATRIAL NODAL BRANCH, SA NODAL ARTERY, RIGHT SA NODE BRANCH.

The artery of the sinus node is the main artery that ensures the blood supply to the sinus-atrial node, and its damage leads to irreversible violations of the rhythm of the heart. The ACS also participates in the blood supply to the majority of the inter-subsensudual partition and the front wall of the right atrium.

The artery of the sinus node, as a rule, departs from the dominant artery (see the types of blood supply to the heart). With the right type of heart blood supply (about 60% of cases), the ACS is the second branch of the right coronary artery and departs from PKA opposite the place of dishevement of the conical artery, but can be separated from the 1st facial sine on its own. With the left type of blood supply to the heart, the artery of the sinus node is departed from the envelope of the branch of the LKA.

The Sinoatrial Nodal Artery (Sana) Supplies Blood to the Sinoatrial Node (SAN), Bachmann "S Bundle, Crista Terminalis, And the Left and Right Atrial Free Walls. The Sana Most Frequently Originates From Either The Right Coronary Arttery (RCA) Or The Left Circumflex Branch (LCX) of the Left Coronary Arttery (LCA).

Artery Kyugel (big ear artery).
Kugel "S Arttery, Atrial Anastomotic Branch, Kugel" S Anastomotic Branch (Lat.: Arteria Auricularis Magna, ARTERIA ANASTOMOTICA AURICULARIS MAGNA, RAMUS ATRIALIS ANASTOMOTICUS).

Artery Kyugel is an anatomosing between the systems of the right and left coronary arteries. In 66% of cases, it is a branch of the LCA or the artery of SPU, departing from it, in the 26% branch of both coronary arteries or the arteries of SPU, departing from them at the same time, and in 8% of cases - the branch of smaller branches that are from the right and left coronary Arteries to atria.

Adva. - Adventitious artery.

Third branch of PKA. Adventitious artery may be a branch of the conical artery or to move independently from the aorta. It is directed up and right and lies on the front wall of the aorta (above the blue monitural connection), heading to the left and disappearing in a fatty case surrounding the main vessels.

AOK - the artery of the acute edge (the right edge artery, the right edge branch, the branch of the sharp edge).
Acute Marginal Artery, Right Marginal Branch, Right Marginal Artery.

The artery of the sharp edge is one of the largest branches of PKA. It descends from PKA on the acute right edge of the heart and forms powerful anastomoses with PMW. Participates in the nutrition of the front and rear surfaces of the sharp edge of the heart.

A.Pu - artery atrial and ventricular node (artery atrioventricular node).
AV Node ARTERY, AV NODAL ARTERY (Branch), AVN ARTERY.

Artery (branch) of the preservative knot departs from the PKA in the field of the head of the heart.

ZMZHV - rear interventricular branch, rear interventricular artery, rear downward artery.
Posterior Descending ARTERY (PDA), Posterior Interventricular ARTERY (PIA).

The rear interventricular branch can be a direct continuation of the PKA, but is more often its branch. It takes place in the rear interventricular furrow, where he gives the rear septal branches, which are anastomosed with the septal branches of the PMF and nourish the terminal departments of the conductive heart system. With the left type of blood supply to the heart, ZMZHV receives blood from the left coronary artery, leaving the envelope of the branch or PMF.

Rear septal branches, bottom septal (partitioned) branches.
Posterior Septal Performators, Posterior Septal (Perforating) Branches.

The rear ("lower") septal branches depart from the ZMZHV in the rear interventricular furrow, which is anastomized with the "front" septal (feminine) branches of the PMWC and feed the terminal departments of the conductive heart system.

The posterior branch of the left ventricle (posterior left venture branch).
Right Posterolateral ARTERY, POSTEROLATERAL ARTERY (PLA), POSTERIOR LEFT VENTRICULAR (PLV) ARTERY.

Approximately in 20% of cases of PKA forms the posterior branch of the left ventricle.

Left coronary artery and its branches

LKA - Left coronary artery (LVA - left coronary artery, OS LKA - the main trunk of the left coronary artery, the trunk of the left coronary artery, the main trunk of the left coronary artery).
Left Coronary Artery (LCA), Left Main Coronary Artery (LMCA), Main Stem Of The Left Coronary Arttery, Left Main Stem.

As a rule, the left coronary artery moves with one barrel from the left (2nd facial) of the aorta sinus. The LKA trunk is usually short and rarely exceeds 1.0 cm., Envelops a pulmonary trunk, and at the level of the non-unitary sinus of the pulmonary artery, it is divided into branches, more often than two: PMIV and s. In 40-45% of the cases of the LCA, even before division on PMF and OB can give an artery that feeds the sine node. This artery can also depart from the LKA.

The LMCA TYPICALY ORIGINATES From the Left Sinus of Valsalva (LSV), Passes Between The Right Ventricle Outflow Tract and the Left Auricle and Quickly Bifurcates Into The Lad and The LCX ARTERIES. ITS NORMAL LENGTH VARIES FROM 2 mm To 4 cm.

The left coronary artery trunk - division on PMJ and OV
A source:Coronary Anatomy and Anomalies. Robin Smithuis and Tineke Willems. Radiology Department of The Rijnland Hospital LeiderDorp and The University Medical Center Groningen, The Netherlands.

PMIV - front interventricular branch (front descending artery, left front descending artery, left front interventricular artery).
Left Anterior Descending ARTERY (LAD), Anterior Interventricular ARTERY (AIA), Anterior Descending Coronary Arttery.

The front interventricular branch is departed from the draft barrel and goes down along the front interventricular partition. In 80% of cases, it comes to the top and, having encouraged it, goes to the rear surface of the heart.

The right-hand branch

The right-handing branch is a non-permanent Branch of the PMWhv, departs from the PMD on the front surface of the heart.

Septal branches of PMF (partition branches of PMZHV, "front" partition branches).
Septal Performators, The Septal Branches, The Septal Perforator Branches, Perforator Branches.

The septal branches of PMGV varies greatly in size, number and distribution. Large the first septal branch of the PMWh (it is the front septal branch, front septal artery, 1st SV) It feeds the front part of the interventricular partition and participates in the blood supply to the conductive system of the heart. The remaining septal branches of the PMZHV ("front"), as a rule, have a smaller size. They are reported with similar stem branches of ZMZHV ("lower" septal branches).

The diagonal branch of the PMZH (DV - diagonal branches, diagonal artery).
DIAGONAL ARTERIES (DB - Diagonal Branches), The Diagonals.

Diagonal branches are departed from PMD and follow along the front-flying surface of the left ventricle. There are several of them, indicate numbers from top to bottom: 1st, 2nd, 3rd diagonal arteries (branches). Breakfast front of the left ventricle. The first diagonal branch is usually one of those branches that feed the top.

Middle artery (intermediate branch)
Intermediate Arttery, Intermediate Branch, Ramus Intermediate (RI), Median (Intermedian) Branch.

Approximately 20-40% of cases, the draft barrel is not divided into two, but for three branches: the "diagonal branch" departs from the barrel of the LKA along with the OV and PMF and, in this case, it is called the median artery. Middle artery is equivalent to the diagonal branch and supplies blood free wall of the left ventricle.

The Ramus Intermedius (RI) IS An Arttery Arising Between The Left Anterior Descending ARTERY (LAD) AND THE CX. Some Call It A HIGH DIAGONAL (D) Or a high Obtuse Marginal (OM) ARTERY.

In This Normal Variant, The LMCA CAN TRIFURCATE INTO A LAD, A LCX AND A RAMUS INTERMEDIUS. The Ramus Intermedius Typically Supplies Theater and Inferior Walls, Acting As a Diagonal or Obtuse Marginal Branch, While The Airlies That Usually Supply This Territory Are Small or Absent.

Anatomy of coronary blood circulation Very variable. Features of the coronary blood circulation of each person are unique, like fingerprints, therefore every myocardial infarction "individual". The depth and prevalence of heart attack depends on the intertwining of many factors, in particular from the congenital anatomical features of the coronary channel, the degree of development of collaterals, the severity of atherosclerotic lesion, the presence of the "Prodroms" in the form of a angina, which first arose during the previously infarction of the day (ischemic "myocardium training), spontaneous or non-yathedral reperfusion, etc.

As known, a heart It receives blood of two coronary (coronary) arteries: the right-wing artery and the left corona artery [respectively, a. Coronaria Sinistra and Left Coronary Arttery (LCA)]. These are the first branches of the aortes that depart from the right and left sinus.

SCRAP [In English - Left Main Coronary Arttery (LMCA)] departs from the top of the left sinus aorta and goes behind the pulmonary trunk. The diameter of the model barrel is from 3 to 6 mm, the length is up to 10 mm. Typically, the draft barrel is divided into two branches: anterior interventricular branch (PMW) and envelope (Fig. 4.11). In 1/3 cases, the draft barrel is not divided into two, but by three vessels: anterior interventricular, envelope and median (intermediate) branches. In this case, the median branch (Ramus Medianus) is located between the front interventricular and the envelope branches of the LKA.
This vessel - an analogue of the first diagonal branch (see below) and usually supplies the front-wind vessels of the left ventricle.

Front interventricular (descending) LKA branch It follows from the front interventricular furrow (Sulcus Interventricularis Anterior) in the direction of the heart. In English literature, this vessel is called the left front descending artery: Left Anterior Descending ARTERY (LAD). We will adhere to more accurate anatomically (F. H. Netter, 1987) and adopted in the domestic literature the term "front interventricular branch" (O. V. Fedotov et al., 1985; S. S. Mikhailov, 1987). At the same time, when describing the coronaryograms, it is better to use the term "front interventric arterry" to simplify the name of its branches.

Main branches latest - Partitions (penetrating, septal) and diagonal. Partition branches depart from the PMW at a right angle and deepen into the crowd of the interventricular partition, where they are anastomized with similar branches, departing from the bottom from the rear interventricular branch of the right coronary artery (PKA). These branches may differ in quantity, length, direction. Sometimes there is a large first partition branch (running either vertically or horizontally - as if parallel to the PMW), from which the twigs are departed to the partition. It should be noted that from all areas of the heart, the interventricular septum of the heart has the most thick vascular network. The diagonal branches of PMW pass along the front surface of the heart, which and blood supply. Such branches happens from one to three.

In 3/4 cases of PMW It does not end in the area of \u200b\u200bthe top, and, richly the last right, turns into the diaphragm surface of the back wall of the left ventricle, blood supply, respectively, as the top and partially posterior damage left ventricle. This is explained by the appearance of q to the EGG in the AVF assignment in a patient with an extensive front infarction. In the remainder cases, ending at the level or not reaching the top of the heart, the PMW does not play a significant role in its blood supply. Then the top receives blood from the rear interventricular branch of the PKA.

Proximal plot front The interventricular branch (PMW) of the LKA is called a segment from the mouth of this branch until the first partitioning (penetrating, septal) branch or before the deposition of the first diagonal branch (less strict criterion). Accordingly, the average portion is a segment of the PMW from the end of the proximal section until the second or third diagonal branch dishes. Next, the distal PMW site is located. When there is only one diagonal branch, the boundaries of the middle and distal sites are determined approximately.

Educational video of blood supply to the heart (anatomy of arteries and veins)

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Artery.
The blood supply to the heart is carried out by two arteries: the right corverity artery, a. Coronaria Dextra, and the left cornen artery, a. Coronaria Sinistra, which are the first branches of the aorta. Each of the coronary arteries comes out of the corresponding aorta sinus.

Right Crown Artery, a. Coronaria Dextra, originates from the aorta at the level of the right sinus, follows the wall of the aorta between the arterial cone of the right ventricle and the right ear in the Crown Grozard. Being covered in their initial departments with the right ear, the artery reaches the right edge of the heart. Here it gives to the wall of the ventricle, the so-called right edge branch, R. Marginalis Dexter, running along the right edge to the top of the heart, and in the area area - a small branch of the sinus-atrial node, R. Nodi Sinuatralis. Near the row of twigs to the wall of the aorta, the ears and arterial cone (the branch of the arterial cone, R. CONI ARTERIOSI), the right corverity of the artery moves to the diaphragmal surface of the heart, where it also lies in the depths of the cornerhead.

Here it sends a twig to the rear wall of the right atrium and the right ventricle (the intermediate atrial branch, R. atrialis intermedius), as well as thin twigs, blood supply and ventricular nodes and accompanying the preservative beam, - the branches of the atrocadic node. RR. Nodi atrioventricularis. On the diaphragmal surface, it comes to the rear interventricular furrow of the heart, in which it descends in the form of the rear interventricular branch. r. Interventricularis Posterior. The last approximately on the border of the middle and lower thirds of this furrow is immersed in the thickness of myocardium. It is bloodtained the rear interventricular septum department (partitioned interventricular branches, RR. Interventriculares Septales) and rear walls both right and left ventricle.

At the place of transition of the main barrel to the interventricular furrow, a large branch, turning around the corrosion on the left half of the heart, and feeds the rear walls of the left atrium and left ventricle with its branches.

Left cornese artery, a. Coronaria Sinistra, larger than right. It begins at the level of the left sinus aorta, it is necessary to the left behind the root of the pulmonary trunk, and then between him and the left ear. Going to the left side of the Vernali groove, even behind the pulmonary trunk is divided most often into two branches: the front interventricular branch and the envelope branch.

1. Front interventricular branch, r. Interventricularis Anterior, is a continuation of the main trunk. Descends on the front interventricular furrow to the top of the heart, envelopes it and enters the end department of the rear interventricular furrow; Without reaching the rear interventricular branch, it is immersed in the thickness of myocardium, giving a number of partitioned interventricular branches, RR. Interventriculares Septales. On the way, it sends a twig to the arterial cone (branch of the arterial cone, r. Sni ARTERIOSI), to the nearby sites of the walls of the left and right ventricles, a larger branch - to the front of the interventricular partition, anastomotic twigs to the trunks from the right corveneous artery and completely blood supply to the top Hearts.

Near its beginning, the front interventricular branch gives a diagonally going rather powerful lateral branch, R. Lateralis, which sometimes begins from the main trunk of the left corneous artery. And in that and in another case, it branches in the field of the front wall of the left ventricle.

2. Enveling branch, r. Circumflexus, coming out from under the left ear, follows from the cornerland to the pulmonary (side) surface of the heart and then along the back of the coronary of the corrger on the diaphragmal surface of the heart, during the transition to which the large branch, feeding the front and rear walls of the left ventricle - rear Branch of left ventricle, r. Posterior Ventriculi Sinistri. Coming out from under the left ears, the artery gives a large left edge branch, r. Marginalis Sinister, which follows the book and a few kice along the pulmonary (side) surface of the heart, heading towards the top of the heart, and ends in the front puffy muscle. Without reaching the rear interventricular furrow, the envelope branch descends along the diaphragm surface of the left ventricle, but the tops of the heart does not reach. On his way, she sends a twig to the walls of the left ear and the left atrium, which depart from the intermediate atrial branch, R. Atrialis Intermedius, passing under a large vein of the heart on the diaphragmal (lower) surface of the left atrium. In addition, an anasthomatic atrial branch is departed from the left corneous artery at the removal of the rear branch of the left ventricle, R. Atrialis Anastomoticus, which anastomoses with branches of the right corner artery in the field of venous sinus.

Sometimes the envelope branch sends the non-permanent branches of the sine-atrial and atrial and ventricular nodes, RR. NODI SINUATRIALIS ET ATRIOVENTRICULARIS, anatomosing with the same names with the right corvene artery.

Thus, the right cornopian artery is heavily suited the walls of the pulmonary trunk, aortic, right and left atrial, right ventricle, the back wall of the left ventricle, the interpresentation and interventricular partitions.

The left cornese artery is bloodtained the walls of the pulmonary trunk, aortic, right and left atrial, the front walls of the right and left ventricles, the rear wall of the left ventricle, the interpresentation and interventricular partitions.

The angry arteries of the hearts anastomize among themselves in all its departments, with the exception of the right edge and the pulmonary (side) surface of the heart, which are blood supply to only relevant arteries.

In addition, there are delivered anastomoses formed by vessels that feed the wall of the pulmonary trunk, aortic and hollow veins, as well as vessels of the rear wall of the atria. All these vessels are anastomosed with the arteries of the bronchi, aperture and pericardium.

In addition to interventic anastomoses (intercoronary), the anastomosis of the branches of the same artery (intrakoronary) is very well developed in the heart.

The intraongogenic artery of the heart, especially in the area of \u200b\u200bthe ventricles, repeat the course of muscle beams: within the limits of the outer and deep layers of myocardium, as well as the papillary MGSH arteries are directed along the longitudinal axis of the heart, and on the middle of the myocardium layer they have a transverse direction.

Vienna.
Most of the heap veins, Venae Cordis (except for small and front), brings blood to a special bench of the bearer sinus, opening in the rear cavity of the right atrium, between the hole of the lower hollow vein and the right atrial-ventricular hole.

The bearer sinus, Sinus Coronarius, as it would be a continuation on the diaphragm surface of his heart of its large vein. It is located on the left side of the back of the cornese furrow, throughout the place of reference to it on top of the oblique veins of the left atrium to his mouth: its length is 2 - 3 cm. A thin elephant of muscle beams of myocardium is thrown over the corinese sinus, at the expense of which its average shell is also formed. , Tunica Media.

Ostium Sinus Coronarii, the Ostium Sinus Coronarii, in the cavity of the right atrium, is focused on the flap of the coronary sinus, Valvula Sinus Coronarii. Two or three small dampers are also in the sinus itself, not far from his opening.

The crude sinus system includes the following veins.
Large Vienna Heart, V. Cordis Magna, begins on the front surface of the top of the heart. At first she lies in the front interventricular furrow next to the descending branch of the left cornen artery. Having reached up to the cornese furrow, it is located in it and goes at the bottom boundary of the left atrium to the pulmonary (side) surface of the heart. Cutting it into it, the large vein falls into the diaphragmal part of the corn-free groove, where it passes without a sharp border in the bemark sinus. Sometimes there is a small damper at the place of the transition of a large vein of hearts in a bemark sinus.

The veins of the front surface of both ventricles, the interventricular partition and sometimes near the sinus - the rear vein of the left ventricle are falling into the larger vein of the heart.

1. Kosy Vienna of the left atrium, V. Obliqua Atrii Sinistri, begins on the lateral wall of the left atrium and goes left to right down in the form of a small twig in the passage of pericardia. Going down and right on the back wall of the left atrium, it goes into a bemark sinus. At the mouth of this vein sometimes there is a small damper.

2. Rear vein left ventricle, v. Posterior VENTRICULI SINISTRI, originates on the posterior wall of the left ventricle, is directed up and flows into either in a large vein of the heart, or directly into the bemark sinus.

3. The average vein of the heart, v. Cordis Media, begins on the diaphragmal (lower) surface in the top of the heart, passes in the rear (bottom) interventricular furrow next to the interventricular branch of the right corner artery and flows into the right end of the crown sinus. On the way he takes a branch from the diaphragmal surface of both ventricles. In the field of heart clipping, anastomoses with a large vein of the heart.

Small vein heart, v. Cordis Parva, begins on the right edge of the right atrium and the right ventricle, it takes place in the back of the cornquiest groove and falls into either the right end of the coronary sinus, either independently opens into the cavity of the right atrium, sometimes in the middle vein of the heart.

Outside the system of coronary sinus describe the following veins:

1. Front Vienna Hearts, VV. Cordis Anteriores, have a different value. They originate in the field of the front and side walls of the right ventricle, are heading up and right to the cornerwood and fall directly into the right atrium; In the mouth of the front veins sometimes there are a minor valve values.

2. The smallest veins of the heart, VV. Cordis Minimae - a group of small veins collecting blood from various parts of the heart and opening openings of the smallest veins, Foramina Venarum Minimarum, directly to the right and partly in the left atrium, as well as in the ventricles.