Summary
The artery of the sino-atrial node was studied in 100 normal human hearts after injection of each coronary artery with coloured gelatine containing a radiopaque substance. The hearts belonged to 69 males and 31 females, being 64 Caucasians and 36 non-Caucasians (Negroes and Mulattoes) whose age ranged from 7 to 80 years. Since the individuals had committed suicide or were victims of accidents, their hearts, after pathologists' evaluation, were considered normal. The sinoatrial node of the normal human heart is supplied by the right coronary artery more frequently (58%±4.9% of the cases) than by the left (42%±4.9). The right anterior medial atrial artery, originating from the right coronary at the level of the medial third of the right anterior quadrant of the atrial dome, is most frequently (50%±5) responsible for the blood supply of the sinoatrial node. Among the branches of the left coronary artery, the left anterior medial atrial artery, originating at the level of the medial third of the left. anterior quadrant of the atrial cupola, was the most frequent blood supplier (25%±4.3) of the sinoatrial node. The origin of the artery of the sinoatrial node from the proximal portion or trunk of the left coronary artery was less frequent (12%±3.2) than the origin from the circumflex artery (30%±4.5). Neither sex nor race influenced the variations of the origin of the sino-atrial node.
Résumé
L'a. du noeud sinu-atrial a été étudiée sur 100 coeurs humains normaux après injection de chaque a. coronaire à la gélatine colorée additionnée d'une substance radio-opaque. Les coeurs provenaient de 69 hommes et 31 femmes, 64 caucasiens et 36 non caucasiens (nègres et mulâtres) âgés de 7 à 80 ans. Ces sujets étant décédés par suicide ou des suites d'accidents, leurs coeurs ont été considérés comme normaux après examen anatomo-pathologique. Le noeud sinu-atrial du coeur humain est vascularisé par l'a. coronaire droite plus fréquemment (58 %±4,9) que par l'a. coronaire gauche (42 %±4). L'a. atriale antéro-médiale droite, issue de l'a. coronaire droite au niveau du tiers médial du quadrant antérieur droit du dôme atrial est l'artère la plus fréquemment en cause (50 %±5) dans la vascularisation du noeud sinuatrial. Parmi les branches de l'a. coronaire gauche, l'a. atriale antéro-médiale gauche, née au niveau du tiers médial du quadrant antérieur gauche du dôme atrial, était la branche la plus fréquemment en cause (25 %±4,3) dans la vascularisation du noeud sinu-atrial. La naissance de l'a. du noeud sinu-atrial à partir de la partie proximale ou du tronc de l'a. coronaire gauche était moins fréquente (12 %±3,2) que son origine à partir du rameau circonflexe (30 %±4,5). Les variations d'origine de l'a. du noeud sinu-atrial n'apparaissaient pas influencées par le sexe ou la race.
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References
Algorri-Pisano I (1954) Contribucion al estudio radiografico de las artérias coronarias. Arch Inst Cardiol (México) 29: 303–327
Anderson RH, Ho SY, Becker AE (1983) The surgical anatomy of the conduction tissues. Thorax 38: 408–420
Balboni GC, et al. (1979) Anatomia Umana, 2nd edn. EE-Edi Ermes, Milano
Baltaxie HA, Amplatz K, Levin DC (1975) Coronary Angiography. Thomas, Spring-field
Baroldi G, Mantero O, Scomazzoni G (1956) Circolo Anastomotico Arterioso Coronarico nel Cuore Normale e Patologico (Monografia). Milano
Basmajian JV (1975) Grant's method of anatomy, 9th edn. Williams & Wilkins, Baltimore
Bekeier J (1971) Die Anatomie des Reizleitungssystems bei Operationen von Vorhofseptumdefekten. Thorax Vaskilaere Chir 19: 41–46
Benninghoff A (1980) Blutgefässe und Herz. In: Von Möllendorff W (ed) Handbuch der mikroskopischen Anatomie des Menschen. Springer, Berlin
Bharati S, Molthan ME, Veasy G, Lev M (1979) Conduction system in two cases of sudden death after the Mustard procedure. J Thorac Cardiovasc Surg 77: 101–110
Boas EP, Boas NF (1949) Coronary artery disease. Year Book Publishers, Chicago
Bokeriya LAL, Mikhailin SI, Revishvili SH (1984) Anatomical variants of sino-atrial and atrioventricular node arteries. Cor et Vasa (Praha) 26: 220–228
Burns BI, Ronstrom GN (1938) Coronary disease. In: Symposium on The blood supply of the heart wall. New Orleans Med Surg J 90: 511–514
Busquet J, Fontana F, Anderson RH, Ho SY, Davies MJ (1984) The surgical significance of the atrial branches of the coronary arteries. Int J Cardiol 6: 223–234
Campbell JS (1929) Stereoscopic radiography of the coronary system. Quart J Med 22: 247–667
Chazov EI, Dorofeeva SS, Vikhert AM, Vinogradov AV (1979) Myocardial infarction; the approach to preventions, diagnosis and treatment in the Soviet Union. Littleton
Chevalier PA (1976) The heart and circulation; Benchmark papers in the human physidogy, 8th edn. Dowden Hutchinson & Ross, Pensylvania
Clarke JA (1965) An X ray microscopic study of the arterial supply to the conducting system of the human heart. Br Heart J 27: 879–881
Clerc MA (1931) Anatomie médicale des artères coronaires. J Med Fr 19: 37–40
Correia M (1933) Contribution à l'étude de la circulation artérielle du coeur. Fol Anat Univ Conimbr 21: 1–6
Crainicianu A (1922) Anatomische Studien über die Coronarterien und experimentelle Untersuchungen über ihre Durchgängigkeit. Virchows Arch 238: 1–75
Davies J, Anderson RH, Becker AE (1983) The conduction system of the heart. Butterworths, London
DiDio LJA, Wakefield TW (1972) Origin, classification, nomenclature and incidence of the atrial arteries in normal hearts, with special reference to their clinical importance. Acta Cardiol 27: 565–595
Domenech M, Orts-Llorca F (1975) Origen insolito de la arteria del nodo sino-atrial a partir de la arteria circumflexa auricular izquierda. Rev Esp Cardiol 28: 357–360
Dubecq ZJ (1927) Vascularisation artérielle de la region sinusienne de l'oreillette droite. Note de la Soc Anatomoclinique Bordeaux
Duomarco J (1943) Conceptos fundamentales sobre la circulacion general en condiciones normales y patologicas. Dia Med 15: 1356–1360
El-Said GM, Gillette PC, Cooley DA, Mullins CE, McNamara DG (1976) Protection of the sinus node in Mustard's operation. Circulation 53: 788–791
Estrada R, Inclan-Guas R (1950) Estudio de algunas variaciones en la distribucion coronaria del hombre y su relacion con la patologia vascular del corazon. Arch Hosp Univ 2: 279–306
Ferrer I (1973) The sick sinus syndrome. Circulation 47: 635–639
Fischer HW, Thomson KR (1978) Contrast media in coronary arteriography; a review. Invest Radiol 13: 450–459
Fracassi H (1939) Proyecto de nomenclatura de las arterias del corazon. Prensa Med Argent 26: 40–45
Frink RJ, Merrick B, Lower HM (1975) Mechanism of the bradycardia during coronary angiography. Am J Cardiol 35: 17–22
Géraudel E (1925) L'artère le l'atrio-necteur. Artère du noeud de Keith et Flack. Presse Med 33: 1283–1286
Goldreyer BN (1974) Sinus node dysfunction; a physiologic consideration involving the sinus node. Cardiovasc Clin 6: 179–198
Gross L (1921) The blood supply to the heart in its anatomical and clinical aspects. Hoeber, New York
Hadziselimovic H (1978) Vascularization of the conducting system in the human heart. Acta Anat 102: 105–110
Hamilton WJ (1980) Bellet's essentials of cardiac arrhythmias, 2nd edn. Saunders, Philadelphia
Henriquez J, Olave E, Matamala F (1989) Ramas arteriales de los nodos del sistema de conduccion cardiaca. An Anat Norm 7: 45–49
Holden MP (1984) Right atrial surgery-arterial pitfalls. Int J Cardiol 6: 235–236
Hromada J (1969) The artery of the sinuatrial node Keith and Flack of the human heart. S B Ved Pr Lek Fak Karlovy Univ 12: 353–357
Hromada J, Voboril Z (1970) Arteries of cardiac atria in man. Folia Morphol 18: 308–321
Hutchinson MC (1978) A study of the atrial arteries in man. J Anat 125: 39–54
James TN (1961a) Myocardial infarction and atrial arrhythmias. Circulation 24: 761–776
James TN (1961b) Anatomy of the human sinus node. Anat Rec 141: 109–116
James TN (1968) The coronary circulation and conduction system in acute myocardial infarction. Prog Cardiovasc Dis 10: 410–419
James TN, Burch GH (1957) Blood supply of the human sinoatrial node. Circulation 16: 898
James TN, Burch GH (1958a) The atrial coronary arteries in man. Circulation 17: 90–98
James TN, Burch GH (1958b) Topography of the human coronary arteries in relation to cardiology. J Thorac Surg 36: 656–664
Jefferson K, Rees S (1980) Clinical cardiac radiology, 2nd edn. Butterworths, Boston
Keith A, Flack M (1907) The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41: 171–189
Kennel AG, Titus JL (1972) The vasculature of the human sinus node. Mayo Clin Proc 47: 556–567
Lagoa TR (1928) De cordis arteriis. Tese de Concurso Docente-Livre Anatomia Humana — Faculdade de Medicina da Universidade do Rio de Janeiro
Lascano EF (1943) La irrigacion normal del nodulo de Keith & Flack. Rev Argent Cardiol 9: 16–40
Laubry C, Soulié P (1950) Les maladies des coronaires, 2nd edn. Masson, Paris
Laurenson RD (1968) An introduction to clinical anatomy by dissection of the human body. Saunders, Philadelphia
Lienhard G, Brechenmacher C, Koritke JG (1977) La vascularisation du noeud de Keith et Flack. Ann Cardiol Angeiol 26: 1321–1324
Lippestad Ct, Marton PF (1967) Sinus arrest in proximal right coronary artery occlusion. Am Heart J 74: 551–556
Loeb JM, Euler DE, Randall WC, Moran JF, Brynjolfsson G (1980) Cardiac arrhythmias after chronic embolization of the sinus node artery: alterations in parasympathetic pacemaker control. Circulation 61: 192–198
Luisada AA (1948) Heart: a physiologic and clinical study of cardio-vascular diseases. Williams & Wilkins, Baltimore
Lutembacher R (1927) Artères des centres d'automocité du coeur et du faisceau de His. Anat Pathol Bull med 41: 1369–1373
McAlpine WA (1975) Heart and coronary arteries. An anatomical atlas for clinical diagnosis, radiological investigation and surgical treatment. Springer, New York
Mandard JC, Voegtlin R, Diesel J (1968) Quelques aspects de la pathologie du noeud sinusal et de l'oreillette droite. Ann Anat Pathol (Paris) 13: 217–225
Martelli D (1919) La Patologia Chirurgica dei Vasi Coronari del Cuore. Bernardino, Siena
Martinez-Osorio L (1970) Aportaciones morfofuncionales al sistema de excitoconduccion y su riesgo a nivel auricular. Anal Anat 19: 113–139
Mignon R (1937) La circulation coronarienne et l'étude expérimentale des ligatures. Thèse Legrand, Paris
Mora I (1935) Contribucion al estudio anatomico de la circulacion coronaria. Arch Latino-Am Cardiol Hemat 5: 65–88
Mouchet A, Noureddine A (1926) Sur l'artère de l'atrio-necteur. Ann Anat Pathol 3: 41–48
Nerantzis CE, Augoustakis D (1980) The atrial artery supplying the sinus node area; an anatomical study. Chest 78: 274–278
Nerantzis CE, Col L (1983) The importance of the sinus node artery in the blood supply of the atrial. Acta Cardiol 38: 35–48
Netter FH (1968) Physiology and pathophysiology. In: Heart. Ciba Pharmaceutical. The Ciba Collection of Medical Illustration, v. 5, New York
Ochsner JL, Mills NL (1978) Coronary artery surgery. Lea & Febiger, Philadelphia
Pace D (1924) Saggio di uno studio anatomoradiografico sulle arterie coronarie nell'uomo e nei mammiferi. Rif Med 40: 1001–1004
Pagan V, Zaccaria F, Losi C, Cigaina V, Zotti EF (1980) Modificazioni del ritmo dopo legatura delle arterie del nodo seno-atriale e contemporanea sezione dei tratti internodali del cuore di cane. Chir Pat Sper 28: 87–97
Paolantonio U (1946) Contributo alla angiografia cardiaca. Ann Ist Osp Aquilani 1: 107–113
Patten BM (1953) The cardiovascular system. In: Schaeffer JP (ed) Morris' human anatomy, 11th edn. Blakiston, New York
Paulsen S, Vetner M (1973) Anatomical variations of the coronary arteries and origin of blood supply of sinoauricular and atrioventricular node determined on the basis of postmortem coronary angiography. Acta Pathol Microbiol Scand 81: 784–790
Pondé AA (1938) Do infarto miocardico; estudo clinico propedeutico. Tese concurso Prof. Catedratico Clinica Propedeutica Medica, Faculdade de Medicina da Bahia
Prates JC, Suzuki K (1978) Contribuiçao ao estudo dos ramos atriais das artérias coronarias no homem. In: Congresso Panamericano de Anatomia. V. Anais, Sao Paulo
Ratnoff OD, Plotz M (1946) The coronary circulation. Medicine 25: 285–342
Resnekov L, Lipp H (1972) Pacemaking an acute myocardial infarction. Prog Cardiovasc 14: 475–490
Roberts NK (1975) The cardiac conducting system and the His bundle electrogram. Appleton-Century-Crofts, New York
Robertson HF (1929) Vascularization of the thoracic aorta. Arch Pathol 8: 881–893
Romhilt DW, Hackel DB, Estes EH (1968) Origin of blood supply to sinoauricular and atrioventricular node. Am Heart J 75: 279–280
Ryback R, Mizeres J (1965) The sinus node artery in man. Anat Rec 153: 23–30
Segre R (1927) La circolazione sanguinea del tessuto nodale cardiaco, e suo rapporto colla fisiologia della contrazione cardiaca. Atti Soc Lombarda Sci Med Biol 16: 363–375
Smith TG (1962) The anatomy of the coronary circulation. Am J Cardiol 9: 327–342
Soulié P (1936) La conception acutelle de la circulation coronarienne. Sem Hôp Paris 12: 226–237
Spalteholz W (1924) Atlante Manuale di Anatomia Umana, 3rd edn. F. Vallardi, Milano
Urwitz S (1937) Arteria septi cordis dextra. Anat Anz 85: 97–110
Verhaeghe L, Hauwaert VD (1967) Arterial blood supply of the human sinus node. Br Heart J 29: 801–806
Vesterby A (1981) Postmortem coronary angiography in histological investigation of the conduction system of the heart in sudden unexpected death due to coronary heart disease. Acta Pathol Microbiol Scand 89: 157–163
Vieweg WVR, Alpert JS, Hagan AD (1975) Origin of the sinoatrial node and atrioventricular node arteries in tight, mixed and left interior emphasis systems. Cathet Cardiovasc Diagn 1: 361–373
Visioli O, Botti G (1957) La morfologia del nodo senoatriale dell'uomo in rapporto all'eta. G Clin Med 37: 1477–1504
Voegtlin R, Diesel J, Mandard JC (1968) La vascularisation du noeud de Keith et Flack. Ann Cardiol Angeiol 17: 321–325
Wakefield TW, DiDio LJA (1970) The blood supply of the sinu-arterial node in normal heart. Proceedings, Midwest Anatomists Association Meeting, pp 23–24
Wiggers CJ (1952) The functional importance of coronary collaterals. Circulation 5: 609–615
Willius FA, Keys TE (1941) Cardiac classics. A collection of classic works ond the heart and circulation with comprehensive biographic accounts of the authors. Mosby, St. Louis
Winckler G (1948) Etude sur les artères coronaires du coeur chez l'homme. Alsacienne, Strasbourg
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DiDio, L., Lopes, A., Caetano, A. et al. Variations of the origin of the artery of the sinoatrial node in normal human hearts. Surg Radiol Anat 17, 19–26 (1995). https://doi.org/10.1007/BF01629494
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DOI: https://doi.org/10.1007/BF01629494