The clinical anatomy of coronary arteries.

In view of the fact that, in cardiology and coronary surgery, peculiarities and anomalies of the coronary arteries pose a great potential risk for myocardial ischemia resulting in arrhythmia, angina, infarction, and sudden death, a survey of the morphology of the coronary arteries in cadaver specimens (n = 200) and corrosion casts (n = 30) was undertaken. The results are not divided into those obtained from subjects with or without coronary heart disease. The randomly selected material from two anatomical institutes, of the Universities of Munich and Würzburg, was considered representative of an average group of septuagenarians and octogenarians in the German population. It is the patient of this age that the young medical students of today (the future physicians) will be confronted with and called upon to treat. The study begins with a review of the nomenclature and a consideration of unofficial (but often clinically used) terms and synonyms for coronary arteries and their branches, followed by a description of modern diagnostic techniques based on the presence of normal and anomalous cardiac vessels. It continues with a demonstration of "normal" macro- and microanatomy, a description of the most frequent ramification pattern and as well of the many peculiarities of the coronary arteries. These are briefly enumerated here: ectopic coronary ostia and aberrant and accessory arteries; angles of origin and division; three-dimensional orientation of the coronary stems; intramural, intraluminal, and intracavitary courses; avascular coronary and interventricular sulci; extracardiac noncoronary myocardial supply; atrial branches, sinuatrial node artery, atrioventricular node artery, principles of septal arterial supply, variations of the right and left superior septal arteries; endomural, intracoronary, intercoronary, and noncoronary anastomoses and collaterals; measurement and evaluation of age-related and atheromatous coronary calcifications; multiple coronary aneurysmata.