CORONARY SYSTEM

Dr. LITA FERIYAWATI, M.Kes

Dr. DWI RITA ANGGRAINI, M.Kes
DEPARTEMEN ANATOMI
FAKULTAS KEDOKTERAN USU

Is the circulation of
blood in
Coronary
the blood
circulation
vessels
of the heart
muscle (the
myocardium).

coronary
arteries
cardiac
veins

The vessels that

deliver oxygen-rich
blood to the
myocardium
The vessels that
remove the
deoxygenated blood
from the heart muscle

ELOPMENT OF THE CORONARY ARTERY

Circ. Res. 2002;91;761-768

Movement of the PEO to and over the heart is shown in the top panel,and
mesenchymal migration and differentiation are shown in the bottom panel.
The PEO (proepicardial organ) (blue) is seen as an outgrowth from the dorsal
body wall that moves to the looping heart (red)
Next, migrating epithelium is seen spreading over the heart. In cross section,
the epithelium is seen as a single cell layer. Epithelial/mesenchymal transition
provides cells that migrate into the myocardium.
Vasculogenic cells differentiate and link to form plexi that induce other
mesenchymal cells to become smooth muscle. These plexi are remodeled into
definitive arteries, and the most proximal points of the major coronarie finally
link up with the aorta.

NORMAL ANATOMY OF THE

CORONARY ARTERIES
The coronary arteries are the first branches
of the aorta, arising usually from two of the
three aortic sinuses of Valsalva
Both of these arteries originate from the left
side of the heart at the beginning (root) of
the aorta, immediately above the aortic
valve.
The left coronary artery originates from the
left
aortic sinus, while the right coronary artery
originates from the right aortic sinus.

Clinical Anatomy 22:114128 (2009)

The right coronary

artery originates
from
the right coronary
sinus of Valsalva.
The left coronary
artery
originates from the
left
Coronary sinus of
Valsalva and after a
short course,
bifurcates
into the anterior
interventricular
artery
and circumflex
artery

Clinical Anatomy 22:114128 (2009)

The two sinuses

adjacent
to the pulmonary
trunk give rise to the
major coronary
arteries, namely the
right coronary artery
and the main stem of
the left coronary
artery.
On the basis of these
origins, therefore, the
aortic sinuses of
Valsalva can be
named as the right
coronary, left
coronary, and

The Right Coronary Artery

The right coronary artery, which in ninetenths of individuals supplies most of
the diaphragmatic surface of the
ventricular mass, emerges from the
right coronary aortic sinus in the upper
part of the right anterior surface of the
aortic root.

Left Coronary Artery

The main stem of the left coronary artery usually arises from the left
coronary aortic sinus slightly below the sinutubular ridge,

Its course is rarely longer than 1 or 2 cm in the adult, after which it

divides
into the circumflex and anterior interventricular branches.

These two arteries, together with the right coronary artery, that make up
the three arteries of so-called 3 vessel coronary arterial disease.

Left Coronary Artery

The trunk of the main stem, at between 5 and 10 mm in
diameter, is typically much larger than the right coronary
artery.

Its branches usually supply a larger volume of myocardium,

including
most of the left ventricle, the muscular ventricular septum, and
the
supero-lateral papillary muscle of the mitral valve, as well as
giving branches to the left atrium, and in just under half the
population also supplying the artery to the sinus node

 A. coronaria dextra :
Ramus nodi sino atrialis
Ramus marginalis
Ramus interventricularis posterior
A. coronaria sinistra :
Ramus nodi sino atrial
Ramus interventricularis anterior
Ramus circumflexus ramus
marginalis

VARIATIONS
Four percent of people have a third, the
posterior coronary artery.
In rare cases, a person will have one
coronary artery that runs around the
root of
the aorta.
Occasionally, a coronary artery will
exist as
a double structure (i. e. there are two
arteries, parallel to each other, where
ordinarily there would be one).

Clinical Anatomy 22:114128 (2009)

Blood supply of the papillary

muscles
If the papillary muscles are not functioning
properly mitral valve may leak during
contraction of the left ventricle mitral
regurgitation.
Similarly, the leaking of blood from the
right ventricle through the tricuspid valve
and into the right atrium can also occur
tricuspid insufficiency or tricuspid
regurgitation.

Blood supply of the papillary

muscles
The anterolateral papillary muscle more
frequently receives two blood supplies: left
anterior descending (LAD) artery and the left
circumflex artery (LCX) more frequently
resistant to coronary ischemia
The posteromedial papillary muscle is usually
supplied only by the PDA. significantly more
susceptible to ischemia.
myocardial infarction involving the PDA is
more likely to cause mitral regurgitation.

ANASTOMOSES

There is some anastomoses

between branches of the two
coronary arteries, however
the coronary arteries are
functionally end arteries.

ANASTOMOSES
There are three areas of anastomoses:
1.Small branches of the LAD (left anterior
descending/anterior interventricular) branch
of the left coronary join with branches of the
posterior interventricular branch of the right
coronary in the interventricular groove
2. Anastomosis between the circumflex artery
(a branch of the left coronary artery) and the
right coronary artery in the atrioventricular
groove.
3. Anastomoses between the septal branches
of the two coronary arteries in the
interventricular septum.

ORONARY ARTERY DOMINANCE

The artery that supplies the

posterior descending artery
(PDA) determines the coronary
dominance

ORONARY ARTERY DOMINANCE

If the posterior descending artery (PDA) is
supplied by the right coronary artery (RCA)
"right-dominant".
If the posterior descending artery (PDA) is
supplied by the circumflex artery (CX)
"left-dominant".
If the posterior descending artery (PDA) is
supplied by both the right coronary artery
(RCA) and the circumflex artery "codominant".
Approximately 70% of the general
population are right-dominant, 20% are codominant, and 10% are left-dominant

CARDIAC VEINS

CARDIAC VEINS

Terima
kasih