Surgical Anatomy of the Coronary Artery Distribution in Congenital Heart Disease

Distribution of major coronary arteries was studied in 154 congenitally malformed hearts and 24 normal hearts. The artery to the atrioventricular node constantly arose in the area of the coronary sinus from either the right or left coronary artery. In specimens with ostium primum malformations, this artery coursed immediately beneath the inferior (dorso-caudad) rim of the defect. Anomalous distribution of the coronary arteries in the region of the right ventricular outflow tract poses a serious problem in openheart surgery. The two most frequent variants were anomalous anterior descending artery arising from the right coronary, and single right coronary artery with the left coronary branch passing across the right ventricular outflow tract. Such anomalies occur most frequently in transposition complexes and tetralogy with extreme dextroposition of the aorta. Fatalities have been reported following division of these vessels. Although some anomalies of the coronary vessels may be recognized on inspection of the heart at the operating table, a major vessel may lie buried within the myocardium.