AUGMENTATION OF THE EXTRACARDIAC ANASTOMOSES OF THE CORONARY ARTERIES THROUGH PERICARDIAL ADHESIONS.

The examination of four hearts, with partial or complete obliteration of the pericardial sac by fibrous adhesions, after injection of the coronary arteries with a colloidal suspension of lamp black showed that the extracardiac anastomoses of the coronary arteries were increased owing to the presence of adhesions. In all four instances a particularly rich injection of the parietal pericardium was obtained and microscopic examination of the adhesions showed them to contain injected vessels, extending from epicardium to parietal pericardium. A microscopic study of cleared blocks (3 mm. in thickness) of myocardium and attached pericardial adhesions, showed the arborization and anastomosis of branches of the arteries of the parietal pericardium with those of the heart. This vascularization was not limited to the usual areas of subepicardial fat, but was seen in regions not ordinarily containing arterial branches. In no one of the four cases were the coronary arteries significantly diseased. In one of the four cases, the normal sites of anastomoses between the cardiac and extracardiac vessels were destroyed by cutting away the great vessels entering and leaving the heart, as well as the peri- and intervascular reflections of parietal pericardium. Injection mass was found however, in the arteries of the parietal pericardium and the diaphragm, showing that it has passed directly through the adhesions from coronary to extracardiac vessels. If the extracardiac anastomoses of the coronary arteries constitute a significant reserve for cardiac circulation, it would appear that this reserve would be augmented by the presence of pericardial adhesions. Direct communication between branches of the coronary arteries and the pericardial branches of the internal mammary arteries with free anastomosis with the anterior branches of the thoracic aorta is established over areas corresponding to the extent of the adhesions. Work is now in progress in this laboratory to study the functional significance of such an experimentally induced collateral circulation in experimental coronary occlusion.