SUMMARY In patients with occlusion of the left anterior descending coronary artery (LAD) or right coronary artery (RCA), the conus artery, which arises at or near the origin of the RCA, often serves as a principal source of collateral circulation. Coronary arteriograms in 508 adult patients revealed that in 80.5% the conus artery was well visualized on the RCA angiogram, but that in 19.5% it was not adequately visualized due to injection of contrast distal to its origin. In the latter patients, the presence of conus-LAD or conus-RCA collaterals might therefore go undetected. Because the degree of distal filling via collateral circulation affects medical and surgical decisions, it is important to attempt to visualize the conus artery adequately whenever the LAD or RCA is obstructed. THE CONUS ARTERY supplies coronary blood flow to the conus, or outflow tract, of the right ventricle and is generally considered to be the first branch of the right coronary artery (RCA). On coronary arteriograms, the conus artery is generally viewed in the left anterior oblique (LAO) and right anterior oblique (RAO) projections (figs. 1-5). In the LAO projection it initially passes cephalad, then turns caudally and slightly laterally after reaching the apex of the right ventricular outflow tract. In the RAO projection, its initial upward course is again seen as it passes toward the anterior aspect of the heart. It terminates by ramifying near the anterior interventricular groove, which contains the left anterior descending artery (LAD).The principal importance of the conus artery in adult patients with coronary artery disease (CAD) is to serve as a major source of collateral circulation when the LAD becomes obstructed.' To a lesser extent, the conus artery can also collateralize the distal segment of an obstructed RCA (figs. 1 and 2).Careful anatomic studies2-4 have shown that in approximately 50% of human hearts, the conus artery is actually not a branch of the RCA but arises instead from a discrete ostium in the right sinus of Valsalva close to, but separate from, the RCA ostium. When such patients undergo coronary arteriography, selective catheterization and contrast injection into the RCA might fail to opacify the conus artery. Serious underestimation of the extent of collateral circulation in patients with LAD or RCA disease could result under these circumstances. The purpose of this study was No. 4, 1981. to determine how often this anatomic variation results in failure to visualize the conus artery adequately during selective coronary arteriography.
MethodsWe prospectively analyzed coronary cinearteriograms performed in 508 adult patients with suspected CAD. Two-thirds of the studies were performed using the Judkins percutaneous femoral technique, and the rest were performed using the Sones brachial arteriotomy technique. Cases were included in the study only if both LAO and RAO views of the RCA were obtained. The arteriograms were classified according to whether they visualized the conus artery adequately, inadequately, o...
Cardiac injuries following nonpenetrating chest trauma have been reported. These include cardiac arrhythmias, septal damage, valve damage, coronary fistula, coronary artery damage, ventricular aneurysm, cardiac rupture, and myocardial infarction. Myocardial infarction as a complication of chest trauma has been reported in very few cases. In this report the authors describe a patient who developed anterior wall myocardial infarction secondary to a blunt chest trauma.
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