Anomalous Origin of the Coronary Arteries in Animals

Transcription

Path. vet. 5: 313-326 (1968)
From the Laboratory for Experimental Surgery, Free University of Amsterdam,
the Netherlands (Head, Prof. G. den OTTER,
M.D.)
Anomalous Origin of the Coronary Arteries
in Animals
The literature contains numerous recorded instances of anomalous origin of the coronary arteries in domestic animalsls. 15a especially cattle, and in human being$, 1%1L18-21, 23, 27,31.37, 39,42, more
frequentIy in the latter. I did not find any report of such anomaly in
swine. Anomalous origin of the coronary arteries is reported in this
paper in 10 cattle, 1 domestic pig, and 1 deer.
Review of Literature
GODGLuCK15reviewed the veterinary literature to 1941 and added
a description of a case of anomalous origin of the right coronary artery
from the pulmonary trunk in a cow. VINKet al.38 reported 8 cases of
such an anomaly, all in cattle. V I T U M Sstudied
~~
a cow’s heart with
such an anomaly associated with significant anastomosis between the
two coronary arteries. FISHER
and P I R I Ereported
~~
anomalies of the
coronary arteries in 9 cattle; among these were 2 cases of anomalous
origin of the right coronary artery from the pulmonary trunk.
b S C H K E B g , REID30, SCHAUDER~~,
and RUBLI~~.
34 reported in cattle
aneurysms of the coronary arteries, sometimes communicating with
one of the ventricular cavities. S C H ~ N D U described
B E ~ ~ such an anomaly in a cow but classified it with anomalies of the ventricles.
The reports of cases in cattle are discussed in a comprehensive
review by GODGLuCK15a, but 3 other reports not mentioned by him
need to be cited here. ALTMANN~
found an aneurysmic left coronary
artery communicating with the right ventricle in a 2I/,-year-old ox.
314
VAN
NIE
CHRISTENSEN
and DALGAARD-MIKKELSENgreported 2 cases of ectasia
of a coronary artery-the left in one case and the right in the othercommunicating with the right ventricle in cattle. E M S B reported
O~~
ectasia of both coronary arteries in a 6-year-old cow; the left artery
was 25 and the right 12 mm in diameter instead of the normal 12 and
5 mm respectively.
BAR ONE^ recorded hypoplasia of the left coronary artery associated
with hyperplasia of the right coronary artery in a mule. CERVEN+
and
KAMAN~
studied the heart of a calf with a common stem of the coronary
arteries.
Development of the Coronary Arteries
In general, MARTIN'S^* classic theory of the development of the
coronary arteries in the rabbit is accepted by investigators of cardiac
anomalies. MARTIN
stated that the coronary arteries develop as endothelial sprouts, situated near the distal bulbus cushions.
GRANT^^ described the communication between the arteries and
the veins in the rabbit’s heart. He found that development of the
truncus septum was already established before the primordia of the
coronary arteries were seen.
BEN NETT^ studied the development of the sinusoids and their
communications with the arteries in the pig.
GOLDSMITH
and BUTLER^^ described the development of the coronary circulatory system in the embryonic pig. They stated that all
vessels arose by endothelial budding from preexisting endothelial
sprouts and that the main vessels existed as short sprouts in the 12 mm
stage. In accordance with GRANT^^ and GOLDSMITH
and BUTLER^^,
PAT TEN^^ reported that septation of the truncus arteriosus in the pig
was completed before the 10mm stage.
Gross Anatomy of the Coronary Arteries
The gross anatomy of the coronary arteries of animals is recorded
in the Handbook of Comparative Anatomy by ELLENBERGER
and
BAUM~Z
and in the handbook of Comparative Basic Cardiology by
R o B B ~Both
~ . books give a survey of the normal picture of the course
of the coronary arteries in cattle and pigs. More detailed studies of
R
R
1
315
2
L
L
Figs. I and 2. Diagram of the normal origin and division of the coronary arteries
in the ox (1)and pig (2) for comparison with all subsequent figures.
these vessels in the pig and dog were published by LUMB
and SINGdog and man by B R O ~ W E R ~and
,
in pig by BERG^.
The pattern of origin of the coronary arteries is usually constant
in both ox (Fig. 1) and pig (Fig. 2). The position of the orifice of the
right coronary artery may vary a little. The secondary and further
branches of the coronary arteries do not have a constant source. Some
branches may originate in the Ieft and some in the right coronary stem.
In my illustrations and in the text the veterinary Latin terms as
described in the Basle Nomina Anatomica40 are used:
L E T A R Y ~23,
~ ~ in
Ky
to
notations in Figures
A.O. : Aorta
A.P. : Arteria pulmonalis-pulmonary trunk
L. : Left or anterior
R. : Right or posterior
I : origin a. coronaria sinistra
I1 : origin a. coronaria dextra
1 : ramus descendens anterioris
2
: ramus circumflexus
3
: ramus septalis
4
: ramus septalis
5 : ramus descendens posterioris
6
: ramus circumflexus
7 : ramus septalis
316
VAN
NIE
R
R
A
4
L
L
Fig. 3. Diagram showing aneurysm of both coronary arteries (stippled areas)
which are joined by an anastomosis (arrow).
Fig. 4. Diagram showing absence of the orifice of the left coronary artery. The
wavy lines indicate the anastomoses mentioned in the text.
Report of Cases
Case 1; Fig. 3; Heart 183
The heart of a 6-month-old pig of unknown history had aneurysmatic stems of both coronary arteries, with an anastomosis between
these aneurysms but without other externally visible anomaly.
The origins of both coronary arteries were normally situated. The
orifices, stems, and secondary branches of the arteries were wide. A
very wide vessel connected the stems of both coronary arteries on the
surface of the conus arteriosus, 3 cm below the ring of the semilunar
valves of the pulmonary trunk. The ramus descendens of the left and
the ramus circumflexus of the right coronary artery were very wide
also, but their courses were normal.
The ostium aortae had abnormaIly large cusps; there was aIso a
slight fibrous subaortic stenosis. The pulmonary ostium was normal.
Case 2; Fig. 4; Heart A 4-month-old calf of unknown history came to emergency
slaughter. At autopsy all of its organs and muscles were congested, a
R
317
R
Fig.5. Diagram showing absence of the orifice of the right coronary artery. Note
the branch of the left c.a. passing between the aorta and the pulmonary
trunk to supply the branches of the right c.a.
Fig. 6. Diagram to show origin of the right coronary artery in the pulmonary
trunk (A.P.) instead of in the aorta (A.O.) The wavy lines represent the
anastomoses mentioned in the text.
clear indication of a circulatory insufficiency.Its heart lacked an orifice
for the left coronary artery. The orifice of the right coronary artery
was normally situated. A branch of the right artery passed between
the pulmonary trunk and the aorta and served as the stem of the
left artery; the further course of this left artery was normal. There
was an anastomosis between the septal branches of the right artery
and another one between one of the septal branches and the ramus
dexter. Otherwise, the heart appeared normal.
Case 3; Fig. 5; Heart - (fragment)
The heart of a cow of unknown history and at least 6 years old
lacked any macroscopic anomaly externally. The orifice of the left
coronary artery was correctly situated, but that of the right coronary
artery was lacking. A branch of the left artery passed between the
aorta and the pulmonary trunk and served as the stem of the right
artery; the further course of which was normal. There was no other
anomaly.
318
VAN
NIE
R
R
f5
7
I’
L
L
Fig. 7. Diagram depicting origin of the left coronary artery from the pulmonary
trunk instead of from the aorta.
Fig. 8. Diagram showing aneurysmal anastomoses (stippled area) between the
coronary arteries. The small rectangles indicate islands of normal tissue
amid the aneurysms.
The heart of a cow of unknown history and at least 3 years old
was enlarged to about 1l/z times the normal size. The only malformation was an anomalous origin of the right coronary artery, which
arose exactly above the right cusp of the pulmonary trunk, but thereafter had a normal course. There were some slight anastomoses between the small rani of the right and left coronary arteries. The main
vessels were of normal diameter.
The heart of a 2-month-old calf of unknown history was free of
any macroscopic anomaly. The only malformation was an anomalous
origin of the left coronary artery, which arose exactly above the caudal
cusp of the pulmonary trunk but thereafter had a normal course. The
two coronary arteries did not anastomose grossly and were of normal
diameter.
R
t5
319
R
t5
10
L
Fig. 9.Diagram showing anastomosis (stippled area) between left coronary artery
and left ventricle.
Fig. 10. Diagram showing hypoplasia of the aorta and origin of the right coronary
artery from the aortic wall.
Case 6 ;Fig. 8 ;Heart 1693
A cow of at least 3 years of age and unknown history had a much
larger than normal heart (1 1/2 x).
The right coronary artery originated exactly above the right cusp
of the pulmonary trunk. The courses of both coronary arteries were
normal but there were many aneurysmal anastomoses between them.
The main branches varied in diameter from 8 to 12 mm and the secondary branches between 5 and 8 mm. Obvious coronary arteroventricular anastomosis was lacking.
A cow at least 3 years old and of unknown history had a very
large heart. An aneurysmatic left coronary artery anastomosed with
the left ventricle.
The points of origin and courses of both coronary arteries were
normal. The rami circumflexi were of normal diameter. The origin and
the common stem of the left coronary artery and the ramus descendens
sinister were very wide; the latter ended in a large aneurysm that
opened by a valve into the left ventricle at the apex.
320
VAN NIE
R
R
45
11
+
12
L
L
Fig. f 1. Diagram showing hypopIasia of the pulmonary trunk and common
origin of both coronary arteries from an aneurysm indicated by dotted
lines.
Fig. 12. Diagram showing common origin of both coronary arteries.
The heart of a 2-day-old hog deer (Axisporcinw) that died unexpectedly, had several malformations. These were remarkable hypoplasia of the aorta, a small high ventricular septal defect, premature
closure of the foramen ovale secundum, relative hyperplasia of the
pulmonary trunk, and origin of the right coronary artery from the
aortic wall 2 cm distal to the cusp of the right semilunar valve.
The origin of the left coronary artery was correctly situated; its
diameter conformed with the hypoplasia of the aorta. The course of
the coronary arteries resembled those of normal bovine arteries.
A 2-day-old calf of unknown history had hypoplasia of the pulmonary trunk, 4 caval veins and situs inversus. The heart had a large
high ventricular septal defect. The aorta had 3 normal semilunar cusps,
was situated above the right ventricle, and was widened. An aneurysm
(6 cm in diameter) 3 cm distal to the aortic cusps gave common origin
to the right and left coronary arteries which were otherwise normal.
321
R
R
14
L
L
Fig. 13. Diagram showing common origin of both coronary arteries. The concentric circles indicate stenosis of the pulmonary trunk.
Fig. 14. Diagram indicating hypoplasia of the right coronary artery and hypoplasia
of the aorta.
The heart of a 6-month-old calf of unknown history had a high
ventricular septa1 defect.
The coronary arteries had a common origin immediately distal
and a little to the left of the right semilunar cusp of the aorta but were
otherwise normal. The aorta was in a slight dextroposition; the pulmonary trunk and the aorta had normal semilunar cusps with 3
leaflets.
The heart was from a Cmonth-old calf of unknown history. It was
an extreme case of tetralogy of Fallot, with a common origin of the
coronary arteries, at a little distance from the caudal cusp of the aorta.
The short common branch divided into 3 sub-branches, 2 of which
followed the expected course of the left coronary artery and 1 that of
the right artery; the latter lay to the right and craniad of the aorta. A
small vessel formed an anastomosis between the aorta ascendens and
the main stem of the left coronary artery.
The aorta originated in the right ventricle (double outlet ventricle). The pulmonary trunk had a severe valvular and subvalvular
stenosis.
322
VAN
NIE
The heart of a 6-week-old calf of unknown history had hypoplasia
of the right coronary artery, hyperplasia of the left coronary artery,
high ventricular septal defect, transposition and hypoplasia of the
aorta (double outlet ventricle), stenosis of the isthmus aortae, and
patency of the ductus Botalli s. arteriosus.
The origin of the right coronary artery was hypoplastic and its
septal and circumflex branches were poorly developed. The left coronary artery was slightly hyperplastic. Its common stem was divided
into 2 branches, a ramus circumflexus cranialis and a ramus circumflexus caudalis. The latter divided into the ramus descendens sinister
(anterioris), a ramus septalis, and a ramus descendens dexter (posterioris).
The lesions observed in the 12 cases are summarized in Table I.
TubZe I. Summary of Lesions in 12 Malformed Hearts*
Figure Heart
3
183
Pig
4
5
6
1505
Anomalies of the coronary arteries
anastomosis left c.a. with r.c.a.
one origin of the c.a. (r.c.a.)
one origin of the c.a. (1.c.a.)
origin of the r.c.a. in the pulmonary
trunk
origin of the 1.c.a. in the pulmonary
trunk
origin of the r.c.a. in the pulmonary
trunk
origin of the 1.c.a. is aneurismatic
high origin of the r.c.a.
7
163
8
1693
9
10
11
1687
1689
deer
1607
high origin of the r. and 1.c.a.
12
93
common origin of both the c.a.
13
14
1610
1688
one common stem of the c.a.
hypoplasia of the r.c.a.
hyperplasia of the 1.c.a.
Other Anomalies
aneurisms
aneurisms
ventricular septal defect ;
hypoplasia of the aorta
situs inversusventricular septal defecthypoplasia pulmonary
trunk
high ventricular septal
defect
Tetralogy of Fallot
double outlet ventricle;
hypoplasia of the aorta;
stenosis of the isthmus
aortae
* All cases are bovine except the ones marked pig or deer.
323
Discussion
In the light of my findings a tenable general theory of the genesis
of the coronary arteries does not exist.
In my material anomalous origin of 1 or both of the coronary
arteries from the pulmonary trunk occurred only in the uncomplicate
cases (Table I). Such a position did not occur in association with other
cardiac malformations. If these anomalies be developed under the
influence of an abnormal septation of the truncus arteriosus, one may
expect an anomalous origin of one or both the coronary arteries from
the pulmonary trunk. However, such a condition is unknown in my
collection of congenital anomalies of the heart of cattle and pigs. It is,
therefore, my opinion that the theory of anomalous septation of the
truncus arteriosusl9 10915 as a cause of an anomalous origin of the
coronary arteries is not tenable. This opinion is in accordance with
GRANT^^ and PAT TEN^^ who state that the septation of the truncus
arteriosus is already established before the primordia of the coronary
arteries appear.
The hypothesis of the development of more than two coronary
arterieslgs 2092% 31 and the closure of most of them except the two
remaining ones may be true but it has not been proved. BECKER5
reported small arteries which have their origin in the pulmonary
trunk, but in our cases more than two main arteries did not occur.
The hypothesis of abnormal potentials's 8, 21,399 42, positive or
negative, of the bulbus-truncus cushions to form the primordia of the
coronary arteries may be right but has also not been proved. All our
cases may be developed under such conditions. The endothelial cell
of the embryo has many potentials;however, we know very little about
the mechanism of these processes.
The reasons for the finding of different types of these anomalies
in different species of animals and the human being is also not very
clear. One of the reasons may be that veterinary cases are found in
slaughterhouses, where predominantly healthy animals are examined,
whereas human cases are chiefly found in the postmortem examination
of patients who died of disease. Another reason may be a difference in
the embryogenesis of the arteries. Since we know there is an important
differencein the gross anatomy of the arteries, it seems reasonable to
expect that the second factor will be very important. A more detailed
comparative anatomical and embryological study of the heart is necessary in order to solve these problems.
324
VAN
NIE
Twelve different cases of anomalous origin of the coronary arteries in
animals are reported, 10 from cattle, 1from a pig, and 1 from a deer. The etiology
of these anomalies is not yet clear. The hypothesis of abnormal potential of
development of the bulbus-truncus cushions may be right, though it has not been
proved.
Zwammenfassung
Es wird iiber 12 verschiedene Falle von Anomalien des Herzarterienursprunges bei Tieren berichtet, und zwar bei 10 Rindern, einem Schwein und
einem Reh. Die Atiologie dieser Anomalien ist noch unklar. Moglicherweise ist
die Hypothese eines anomalen Entwicklungspotentials der Bulbus-Truncus-Polster
korrekt, jedoch ist sie noch nicht bewiesen worden.
Acknowledgements
Our thanks are due to Drs. P. ZWART
and A.P. van der LINDEwho supplied
the hearts 1689 and 1687.
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Anomalous Origin of the Coronary Arteries in Animals

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