The clinical anatomy of the conal artery

Coronary arteries have been extensively described and recognized by gross anatomic studies. However, in the clinical setting, the recognition of the conal artery is essential during coronary angiography, as well as certain congenital heart conditions such as tetralogy of Fallot. In order to provide a complete anatomic and physiologic correlation of the actual incidence and distribution of the conal artery we examined 300 formalin fixed hearts with gross dissections and 300 coronary angiograms. The conal artery was identified in all hearts examined and five main patterns were recognized. In Type A (193, 32.1%), the conal artery arose as a branch of the right coronary artery (RCA); in Type B (96, 16%), the conal artery arose from the common coronary ostium with the RCA; in Type C (242, 40.3%), the conal artery took origin from the right aortic sinus as an independent artery; in Type D (48, 8%), multiple conal arteries were present and arose from the RCA as separate branches (32, 66.6%), from a common ostium with the RCA (8, 16.6%) or from the aortic sinus (8, 16.6%); in Type E (22, 3.6%), the conal artery arose as a branch of the right ventricular branch (17, 2.8%) or acute marginal artery (5, 0.8%). The relative prevalence of the five patterns as well as the morphology and the topography of the conal artery varied significantly with the degree of coronary luminal stenosis (as observed during angiography) and also with the degree of hypertrophied ventricular wall (as observed during gross dissections). Clin. Anat. 29:371–379, 2016. © 2014 Wiley Periodicals, Inc.

[1]  Robert H. Anderson,et al.  Etienne‐Arthur Louis Fallot and his tetralogy , 2014, Clinical anatomy.

[2]  F. Cetta,et al.  Echocardiography in Pediatric and Adult Congenital Heart Disease , 2014 .

[3]  A. Kawasaki,et al.  Ischemia-induced Brugada-type ST-segment alternans and Brugada syndrome. , 2010, International journal of cardiology.

[4]  J. Zamorano,et al.  Collateral circulation from the conus coronary artery to the anterior descending coronary artery: assessment using multislice coronary computed tomography. , 2010, Revista espanola de cardiologia.

[5]  Pedro Marcos-Alberca,et al.  Circulación colateral de arteria conal a descendente anterior: valoración con tomografía coronaria multidetector , 2010 .

[6]  P. Koşar,et al.  Anatomic variations and anomalies of the coronary arteries: 64-slice CT angiographic appearance. , 2009, Diagnostic and interventional radiology.

[7]  C. Fraser,et al.  Right Ventricular Infundibulum Sparing (RVIS) Tetralogy of Fallot Repair: A Review of Over 300 Patients , 2009, Annals of surgery.

[8]  Robert H. Anderson,et al.  The clinical anatomy of the coronary collateral circulation , 2009, Clinical anatomy.

[9]  F. Ovčina,et al.  Third coronary artery. , 2008, Bosnian journal of basic medical sciences.

[10]  Wang Wei,et al.  Acute anterior wall myocardial infarction entailing ST-segment elevation in lead V3R, V1 or aVR: electrocardiographic and angiographic correlations. , 2008, Journal of electrocardiology.

[11]  W. B. Meijboom,et al.  Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography , 2008, European Radiology.

[12]  Filippo Cademartiri,et al.  Coronary variants and anomalies: Methodology of visualisation with 64-slice CT and prevalence in 202 consecutive patients , 2007, La radiologia medica.

[13]  R. S. Tubbs,et al.  Raymond de Vieussens , 2007, Anatomical science international.

[14]  F. Laurent,et al.  Congenital coronary arteries anomalies: review of the literature and multidetector computed tomography (MDCT)-appearance , 2007, Surgical and Radiologic Anatomy.

[15]  Cecilia W Lo,et al.  Patterning of coronary arteries in wildtype and connexin43 knockout mice , 2006, Developmental dynamics : an official publication of the American Association of Anatomists.

[16]  H. Abe,et al.  Observation of root variations in human coronary arteries , 2006, Anatomical science international.

[17]  H. Mureşian,et al.  The Ross procedure: new insights into the surgical anatomy. , 2006, The Annals of thoracic surgery.

[18]  M. Turrentine,et al.  Repair of Tetralogy of Fallot with Anomalous Coronary Arteries Coursing Across the Obstructed Right Ventricular Outflow Tract , 2005, Pediatric Cardiology.

[19]  N. Curzen,et al.  Images in cardiovascular medicine. Unexpected profound transient anterior ST elevation after occlusion of the conus branch of the right coronary artery during angioplasty. , 2005, Circulation.

[20]  P. Frommelt,et al.  Congenital coronary artery anomalies. , 2004, Pediatric clinics of North America.

[21]  D. Cokkinos,et al.  Blood flow velocity in donor coronary artery depends on the degree and pattern of collateral vessel development: A study using thrombolysis in myocardial infarction frame count method , 2003, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[22]  M. Asano,et al.  Surgical Repair of Tetralogy of Fallot with Large Conus Artery , 2003, Pediatric Cardiology.

[23]  P. D. M. V. Lüdinghausen.  The Clinical Anatomy of Coronary Arteries , 2003, Advances in Anatomy, Embryology and Cell Biology.

[24]  S. Flamm,et al.  Coronary anomalies: incidence, pathophysiology, and clinical relevance. , 2002, Circulation.

[25]  D. Sahn,et al.  Congenital coronary artery anomalies: the pediatric perspective. , 2001, Coronary artery disease.

[26]  E. Meijboom,et al.  Influence of coronary anatomy and reimplantation on the long-term outcome of the arterial switch. , 2000, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[27]  A. Cook,et al.  Coronary arterial origins in transposition of the great arteries: factors that affect outcome. A morphological and clinical study , 2000, Heart.

[28]  A. Solodky,et al.  Acute anterior wall myocardial infarction entailing st‐segment elevation in lead v1: Electrocardiographic and angiographic correlations , 1998, Clinical cardiology.

[29]  G. Wagner,et al.  Importance of the conal branch of the right coronary artery in patients with acute anterior wall myocardial infarction: electrocardiographic and angiographic correlation. , 1997, Journal of the American College of Cardiology.

[30]  Peter L. Williams,et al.  Gray's Anatomy: The Anatomical Basis of Medicine and Surgery , 1996 .

[31]  L M Boxt,et al.  Introduction to coronary arteriography. , 1994, Radiologic clinics of North America.

[32]  H. Barth,et al.  Congenital Coronary Artery Anomalies , 2008 .

[33]  S. Gupta,et al.  Supernumerary right coronary artery , 1987, Clinical cardiology.

[34]  Waller Bf.  The epicardial coronary arteries: proper necropsy examination. , 1986 .

[35]  C. F. Beckmann,et al.  Frequency and Clinical Significance of Failure to Visualize the Conus Artery During Coronary Arteriography , 1981, Circulation.

[36]  R. Hurwitz,et al.  Tetralogy of Fallot with abnormal coronary artery: 1967 to 1977. , 1980, The Journal of thoracic and cardiovascular surgery.

[37]  R. Drury.  Coronary Heart Disease. Clinical, Angiographic and Pathologic Profiles , 1977 .

[38]  D. Levin.  Pathways and Functional Significance of the Coronary Collateral Circulation , 1974, Circulation.

[39]  T. Crawford,et al.  CORONARY CIRCULATION IN THE NORMAL AND PATHOLOGIC HEART , 1969 .

[40]  W. Wartman.  Coronary Circulation in the Normal and the Pathologic Heart , 1968 .

[41]  F. SerranoMuñoz,et al.  [Tetralogy of Fallot]. , 1958, Revista espanola de tuberculosis.

[42]  G. Baroldi,et al.  The Collaterals of the Coronary Arteries in Normal and Pathologic Hearts , 1956, Circulation research.

[43]  P. Zoll,et al.  The conus artery; a third coronary artery. , 1949, American heart journal.

[44]  M. Sekiya,et al.  A large conus artery in patients with hypertrophic cardiomyopathy , 2005, Heart and Vessels.

[45]  J. Roelandt,et al.  Images in Cardiovascular Medicine , 2000 .

[46]  J. Tamai,et al.  Visualization of isolated conus artery as a major collateral pathway in patients with total left anterior descending artery occlusion. , 1988, Catheterization and cardiovascular diagnosis.

[47]  B. Waller.  The epicardial coronary arteries: proper necropsy examination. , 1986, Indiana medicine : the journal of the Indiana State Medical Association.

[48]  N. Ardlie.  Coronary Heart Disease. Clinical, Angiographic and Pathologic Profiles , 1977 .

[49]  Wallace A. McAlpine,et al.  Heart and Coronary Arteries , 1975 .

[50]  J. Edwards,et al.  Coronary Arterial Variations in the Normal Heart and in Congenital Heart Disease , 1975 .

[51]  J. Hood,et al.  Anatomy of the coronary arteries. , 1973, Seminars in roentgenology.

[52]  B. Received,et al.  Coronary circulation in the normal and the pathologie heart , 1967 .