Objective: The aim of this study was to evaluate the anatomic topography of the circumflex artery (Cx) and left atrial appendage (LAA) and to determine the safety zones for epicardial LAA closure and LAA occlusion procedures. Methods: The left coronary artery was segmented and visualized from 116 computed tomography angiography scans. Four points were located on the Cx portion periappendicularly, starting from the entry point. The landing zone plane was defined as parallel to the LAA orifice at the level of the beginning of the periappendicular course of the Cx, and the plane of the neck bend was located at the end of the LAA neck. A distance smaller than 2 mm was considered a dangerous distance. Results: The distance between the Cx and the LAA landing zone was 4.3 ± 2 mm. The distance between the Cx and the LAA neck bend was 5.1 ± 2.2 mm. The distance between the Cx and the LAA bottom surface was 5.8 ± 2.9 mm. In 38.8% of patients, at least 1 distance between Cx and LAA was smaller than 2 mm in at least 1 dimension. These distances occurred in 30.2% of the LAA landing zone dimensions, 19.8% of LAA neck bend dimensions, and 11.2% of the LAA bottom surface distances. Conclusions: The study showed that most dangerous distances (30.2%) occurred in the LAA landing zone dimension. The data showed that landing zones more distal from the orifice of the LAA are safer in terms of Cx damage. Therefore, LAA closure should always be performed with caution, to avoid iatrogenic complications.

No abstract

Purpose The thoracoacromial trunk (TAT) originates from the second part of the axillary artery and curls around the superomedial border of the pectoralis minor, subsequently piercing the costocoracoid membrane. Knowledge about the location, morphology, and variations of the TAT and its branches is of great surgical importance due to its frequent use in various reconstructive flaps. Methods A retrospective study was conducted to establish anatomical variations, their prevalence, and morphometric data on TAT and its branches. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography were analyzed. A qualitative evaluation of each TAT was performed. Results A total of 15 morphologically different TAT variants were initially established. The median length of the TAT was set at 7.74 mm (LQ 3.50; HQ 13.65). The median maximum diameter of the TAT was established at 4.19 mm (LQ 3.86; HQ 4.90). The median TAT ostial area was set to 13.97 mm (LQ 11.70; HQ 18.86). To create a heat map of the most frequent location of the TAT, measurements of the relating structures were made. Conclusion In this study, the morphology and variations of the branching pattern of the TAT were presented, proposing a new classification system based on the four most commonly prevalent types. The prevalence of each branch arising directly from the TAT was also analyzed. It is hoped that the results of the present anatomical analysis can help to minimize potential complications when performing plastic or reconstructive procedures associated with TAT.

The number of studies on the variations of the branching of the TT is scarce, and those works that treat about the different types of the said trunk are oftentimes inconsistent. Therefore, the authors of the present study would like to propose a set of five types of TT, which were created based on observations of 41 computed tomography angiographies (82 TTs). To establish the anatomical variations, their prevalence, and morphometrical data regarding the TT and its branches, a retrospective study was performed. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography (CTA) were analyzed. The analysis was performed on a total of 82 TTs of 41 patients, aged 15 to 82 years (mean age: 46 years; SD: 18.4), of which 16 (39.0%) were females, and 25 (61.0%) were males. Initially, 11 types of variations were evaluated, of which types 1–4 constituted 89.0%. Furthermore, a new method of classification of the anatomical variations of the TTs has been established. In this study, the variety of the branching and morphology of the TT was presented, proposing its novel classification based on the five most commonly prevalent types. Types 1 and 2 were the most common, with a prevalence of 26.8% each. This work also provides physicians with crucial data about the morphology of the TT and its branches, which can surely be of use when performing endovascular or reconstructive procedures in the cervical region.

This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Folia Morphologica" are listed in PubMed.

Objective: The left internal mammary artery (LIMA) is a common arterial graft in minimally invasive coronary surgery (MICS), such as minimally invasive coronary artery bypass grafting (MIDCAB) or totally endoscopic coronary artery bypass (TECAB). The aim of this study was to perform an analysis of the LIMA operative topography during MICS. Methods: A total of 104 computed tomography angiographies were analyzed retrospectively using 3-dimensional reconstruction and visualization software. Measurements were developed in relation to the anatomical midpoint of the sternal body (SBMP). Parameters were evaluated as lengths, distances, diagonals, or categorical descriptions. Results: A total of 208 internal mammary arteries of each side were analyzed with the following results: (1) LIMA width = 2.7 mm, (2) SBMP–LIMA bifurcation length = 6.2 cm, (3) SBMP–LIMA distance = 3.2 ± 0.5 cm, (4) xiphoid midpoint–LIMA distance = 3.5 ± 0.7 cm, (5) sternal line–LIMA distance = 1.7 ± 0.3 cm, (6) xiphoid end projection–LIMA bifurcation length = 2.2 ± 1.0 cm, (7) midsternal line–LIMA bifurcation distance = 3.3 ± 0.8 cm, (8) xiphoid end–LIMA bifurcation diagonal = 4.1 ± 0.9 cm, (9) LIMA–left coronary artery distance = 7.0 ± 1.4 cm at the proximal and 7.1 ± 1.3 cm at the distal segment, and (10) LIMA–left anterior descending artery distance = 5.5 ± 1.1 cm at proximal, 4.3 cm at middle, and 4.2 ± 1.5 cm at distal segment. The extent of LIMA bifurcation ranged from the level of 5 (1%) to 7 (6%) rib cartilages. Conclusions: Based on the detailed surgical anatomy of LIMA, it was concluded that the fourth intercostal space should be considered as an appropriate approach for MIDCAB or TECAB in the studied region.

No abstract

No abstract