anatomyЖурнал анатомии и гистопатологииJournal of Anatomy and Histopathology2225-7357N.N. Burdenko Voronezh State Medical University10.18499/2225-7357-2020-9-3-16-21anatomy-1152Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL PAPERSЗакономерности распределения миокардиальных мостиков над ветвями венечных артерийRegularities in the distribution of myocardial bridges over the branches of the coronary arteriesДмитриеваЕ. Г.DmitrievaE. G.

ул. Репина, 3, Екатеринбург, 620014, Российская Федерация

ul. Repina, 3, Ekaterinburg, 620014, Russian Federation

ЯкимовА. А.YakimovA. A.

Екатеринбург

Ekaterinburg

ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава РоссииUral State Medical University202009102020931621Copyright © Дмитриева Е.Г., Якимов А.А., 20202020Дмитриева Е.Г., Якимов А.А.Dmitrieva E.G., Yakimov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://anatomy.elpub.ru/jour/article/view/1152

Принято считать, что венечные артерии и их ветви располагаются в подэпикардиальной клетчатке. Между тем, в литературе описаны случаи интрамурального расположения их участков. Вариантами такого расположения являются миокардиальные мостики – совокупность волокон желудочкового миокарда, расположенных поверх определенного участка субэпикардиальной ветви венечной артерии.

Цель – установить закономерности макроскопической анатомии и топографии мостиков миокарда на анатомических препаратах сердца людей зрелого и пожилого возраста.

Материал и методы

Материал и методы. Работа выполнена на 65 фиксированных в формалине препаратах сердца людей зрелого и пожилого возраста, умерших от причин, не связанных с болезнями сердца. Были измерены поперечный и продольный размеры желудочкового комплекса сердца, вычислен поперечнопродольный индекс. Без предварительной инъекции были отпрепарированы субэпикардиальные сосуды. Подсчитывали количество миокардиальных мостиков над главными ветвями венечных артерий и измеряли их длину. Тип кровоснабжения сердца определяли согласно трехчленной классификации в зависимости от источника отхождения задней межжелудочковой ветви.

Результаты

Результаты. Мостики миокарда были отмечены на 44 (67.6%) препаратах. Как правило, они располагались над ветвями левой венечной артерии (91.5%). Их типичной локализацией являлась проксимальная половина передней межжелудочковой борозды. Протяженность мостиков колебались от 2.5 до 64 мм (Me=13 мм). Обнаружена прямая положительная корреляция между длиной желудочкового комплекса сердца и длиной мостиков. Взаимосвязи между типом кровоснабжения сердца и наличием мостиков не выявлено. На 26 препаратах от правого коронарного синуса аорты, помимо правой венечной артерии, отходила конусная артерия, при этом мостики были отмечены на 17 сердцах.

Заключение

Заключение. Мостики миокарда более характерны для ветвей левой венечной артерии по сравнению с правой. Их типичной локализацией является проксимальная треть передней межжелудочковой борозды. Выявлена зависимость между длиной мостиков и длиной желудочкового комплекса сердца. Распределение и количество мостиков миокарда не зависит от типа кровоснабжения сердца, но ассоциировано с самостоятельным отхождением конусной артерии от аорты.

The article highlights peculiarities of localization of myocardial bridges. It is believed that the coronary arteries and their branches are located in the subepicardial tissue. However, some researchers describe cases of intramural localization of their sections. Myocardial bridges – a set of fibers of the ventricular myocardium located over a certain area of the subepicardial branch of the coronary artery - represent variants of such localization.

The aim of the study was to establish the patterns of macroscopic anatomy and topography of myocardial bridges investigating anatomical sections of the human heart in the adult and elderly people.

Material and methods

Material and methods. The study involved 65 formalin-fixed sample preparations of the human heart of the adult and elderly people who died of conditions that were not associated with heart diseases. The authors measured transverse and longitudinal dimensions of the ventricular complex of the heart, and calculated the transverse-longitudinal index. Subepicardial vessels were prepared without prior injection. The number of myocardial bridges over the main branches of the coronary arteries was counted and their length was measured. The type of blood supply to the heart was determined according to a three-member classification, depending on the source of discharge of the posterior interventricular branch.

Results

Results. Myocardial bridges were observed on 44 (67.6%) sample preparations. As a rule, they were located over the branches of the left coronary artery (91.5%). They were typically located in the proximal half of the anterior interventricular sulcus. The length of the bridges ranged from 2.5 to 64 mm (Me = 13 mm). A direct positive correlation was found between the length of the ventricular complex of the heart and the length of the bridges. The relationship between the type of blood supply to the heart and the presence of bridges was not revealed. In 26 preparations, a cone artery departed from the right coronary sinus of the aorta, in addition to the right coronary artery, and bridges were observed in 17 sample preparations.

Conclusion

Conclusion. Myocardial bridges are more typical for the branches of the left coronary artery compared to the right. They are typically localized in the proximal third of the anterior interventricular sulcus. There is a dependence between the length of the bridges and the length of the ventricular complex of the heart. The distribution and number of myocardial bridges does not depend on the type of blood supply to the heart, but is associated with the independent discharge of the cone artery from the aorta.

сердцевенечные артериимостики миокардаheartcoronary arteriesmyocardial bridgesReferencesБагманова З.А. Миокардиальные мостики коронарных артерий. Кардиоваскулярная терапия и профилактика. 2007;6(6):125–30Bagmanova ZA. Myocardial bridges of coronary arteries. Cardiovascular Therapy and Prevention. 2007; 6 (6): 125–30 (in Russian).Бокерия Л.А., Суханов С.Г., Стерник Л.И., Шатахян М.П. Миокардиальные мостики. М.: НЦ ССХ им. А.Н. Бакулева РАМН, 2013Bokeriya LA, Sukhanov SG, Sternik LI, Shatakhyan MP. Miokardial'nye mostiki. Мoscow: Bakulev National Medical Research Center For Cardiovascular Surgery, 2013 (in Russian).Гайворонский И.В., Горячева И.А. Морфометрические характеристики венечных артерий и их ветвей при различных формах сердца. Ученые записки СПБГМУ им. акад. И.П. Павлова. 2011;18(2):49–50IV, Goryacheva IA. Morphometry of the coronary arteries and their branches in different heart outlines. The Scientific Notes of the Pavlov University. 2011;18(2):49–50 (in Russian).Каган И.И., Тютюнникова Н.Н. Мышечные мостики и петли как составная часть топографии венечных артерий сердца и их ветвей. Морфология. 2017; 152 (4): 27–31Kagan II, Tyutyunnikova NN. Myocardial bridges and loops as an integral part of topography of heart coronary arteries and their branches. Morfologiia. 2017;152(4):27–31 (in Russian).Розенберг В.Д., Непомнящих Л.М. Патоморфологические особенности миокардиальных мостиков и их роль в патогенезе ИБС. Бюллетень экспериментальной биологии и медицины. 2002;134(12):685-9Rozenberg VD, Nepomnyashchikh LM. Pathomorphology of myocardial bridges and their role in the pathogenesis of coronary disease. Bulletin of Experimental Biology and Medicine. 2002;134(12):685–9 (in Russian).Сайгитов Р.Т., Чулок А.А. Сердечнососудистые заболевания в контексте социально-экономических приоритетов долгосрочного развития России. Вестник РАМН. 2015; 70 (3): 286–99. doi: 10.15690/vramn.v70i3.1324Saygitov RT, Chulok AA. Cardiovascular Diseases in the Context of Russia’s Long-Term Socio-Economic Development Priorities. Annals of the Russian academy of medical sciences. 2015;70(3):286–99 (in Russian). doi: 10.15690/vramn.v70i3.1324Соколов В.В., Каплунова О.А. Все ли мы знаем о венечных артериях сердца? Морфология. 1996;111(2):112–9VV, Kaplunova OA. Vse li my znaem o venechnykh arteriyakh serdtsa? Morfologiia. 1996;111(2):112–9 (in Russian).Ташник М.А. Вариабельность интрамурального расположения венечных артерий. Клiнiчна анатомiя та оперативна хiрургiя.2009;8(2):29– 35Tashnik MA. Variability of the intramural arrangement of heart coronary arteries. Clinical Anatomy and Operative Surgery. 2009; 8 (2): 29– 35 (in Russian).Achrafi H. Hypertrophic cardiomyopathy and myocardial bridging. International Journal of Cardiology. 1992 Oct;37(1):111–2. doi: 10.1016/0167-5273(92)90138-sAchrafi H. Hypertrophic cardiomyopathy and myocardial bridging. International Journal of Cardiology. 1992 Oct;37(1):111–2. doi: 10.1016/0167-5273(92)90138-sAcunã LEB, Aristeguieta LMR, Tellez SB. Descrição morfológica e implicações clínicas de pontes miocárdicas: um estudo anatômico em colombianos. Arquivos Brasileiros de Cardiologia. 2009 Apr;92(4):242–248. doi: 10.1590/S0066- 782X2009000400002Acunã LEB, Aristeguieta LMR, Tellez SB. Descrição morfológica e implicações clínicas de pontes miocárdicas: um estudo anatômico em colombianos. Arquivos Brasileiros de Cardiologia. 2009 Apr;92(4):242–248. doi: 10.1590/S0066- 782X2009000400002Aksakal A. Prevalence and three-year follow-up of patients with isolated myocardial bridge in the mid-Black Sea region: a retrospective singlecenter study. Turk Kardiyoloji Dernegi ArsiviArchives of the Turkish Society of Cardiology. 2016;44(3):203–6.. doi: 10.5543/tkda.2015.32754Aksakal A. Prevalence and three-year follow-up of patients with isolated myocardial bridge in the mid-Black Sea region: a retrospective singlecenter study. Turk Kardiyoloji Dernegi ArsiviArchives of the Turkish Society of Cardiology. 2016;44(3):203–6.. doi: 10.5543/tkda.2015.32754Arya D, Chauhan K, Bansal M, Mehta CD. Morphological study on myocardial bridges and its clinical significance. An Online International Journal Available. 2013;2(1):32–7.Arya D, Chauhan K, Bansal M, Mehta CD. Morphological study on myocardial bridges and its clinical significance. An Online International Journal Available. 2013;2(1):32–7.Bandyopadhyay M, Das P, Baral K, Chakroborty P. Morphological study of myocardial bridge on the coronary arteries. Indian Journal of Thoracic and Cardiovascular Surgery. 2010 Aug 13;26(3):193–7. doi: 10.1007/s12055-010-0044-6Bandyopadhyay M, Das P, Baral K, Chakroborty P. Morphological study of myocardial bridge on the coronary arteries. Indian Journal of Thoracic and Cardiovascular Surgery. 2010 Aug 13;26(3):193–7. doi: 10.1007/s12055-010-0044-6Bharambe VK, Arole V. The study of myocardial bridges. Journal of the Anatomical Society of India. 2008;57(1):14–21.Bharambe VK, Arole V. The study of myocardial bridges. Journal of the Anatomical Society of India. 2008;57(1):14–21.Cakmak YÖ, Cavdar S, Yalın A, Yener N, Ozdogmus O. Myocardial bridges of the coronary arteries in the human fetal heart. Anatomical Science International. 2010 Sep 1;85(3):140–4. doi: 10.1007/s12565-009-0069-3Cakmak YÖ, Cavdar S, Yalın A, Yener N, Ozdogmus O. Myocardial bridges of the coronary arteries in the human fetal heart. Anatomical Science International. 2010 Sep 1;85(3):140–4. doi: 10.1007/s12565-009-0069-3Fazliogullari Z, Karabulut AK, Kayrak M, Uysal II, Unver Dogan N, Altunkeser BB. Investigation and review of myocardial bridges in adult cadaver hearts and angiographs. Surgical and Radiologic Anatomy. 2009 Dec 2;32(5):437–4. doi: 10.1007/s00276-009-0590-zFazliogullari Z, Karabulut AK, Kayrak M, Uysal II, Unver Dogan N, Altunkeser BB. Investigation and review of myocardial bridges in adult cadaver hearts and angiographs. Surgical and Radiologic Anatomy. 2009 Dec 2;32(5):437–4. doi: 10.1007/s00276-009-0590-zFerreira AG, Trotter SE, Konig B, Decourt LV, Fox K, Olsen EG. Myocardial bridges: morphological and functional aspects. Heart. 1991 Nov 1;66(5):364–7. doi: 10.1136/hrt.66.5.364Ferreira AG, Trotter SE, Konig B, Decourt LV, Fox K, Olsen EG. Myocardial bridges: morphological and functional aspects. Heart. 1991 Nov 1;66(5):364–7. doi: 10.1136/hrt.66.5.364Kosinski A, Grzybiak M. Myocardial bridges in the human heart: morphological aspects. Folia Morphol (Warsz). 2001;60:65–8.Kosinski A, Grzybiak M. Myocardial bridges in the human heart: morphological aspects. Folia Morphol (Warsz). 2001;60:65–8.Loukas M, Curry B, Bowers M, Louis RG, Bartczak A, Kiedrowski M, et al. The relationship of myocardial bridges to coronary artery dominance in the adult human heart. Journal of Anatomy. 2006 Jul;209(1):43–50. doi: 10.1111/j.1469-7580.2006.00590.xLoukas M, Curry B, Bowers M, Louis RG, Bartczak A, Kiedrowski M, et al. The relationship of myocardial bridges to coronary artery dominance in the adult human heart. Journal of Anatomy. 2006 Jul;209(1):43–50. doi: 10.1111/j.1469-7580.2006.00590.xMicic-Labudovic J, Atanasijevic T, Popovic V, Mihailovic Z, Nikolic S, Puzovic D. Myocardial bridges: A prospective forensic autopsy study. Srpski arhiv za celokupno lekarstvo. 2015;143(3– 4):153–7. doi: 10.2298/sarh1504153mMicic-Labudovic J, Atanasijevic T, Popovic V, Mihailovic Z, Nikolic S, Puzovic D. Myocardial bridges: A prospective forensic autopsy study. Srpski arhiv za celokupno lekarstvo. 2015;143(3– 4):153–7. doi: 10.2298/sarh1504153mNarayanan VK, Padmanabhan U. Myocardial bridges and coronary dominance. Journal of Evidence Based Medicine and Healthcare. 2017 Feb 10;4(13):706–10. doi: 10.18410/jebmh/2017/137Narayanan VK, Padmanabhan U. Myocardial bridges and coronary dominance. Journal of Evidence Based Medicine and Healthcare. 2017 Feb 10;4(13):706–10. doi: 10.18410/jebmh/2017/137Nguyen VH, Talarico EF, Jr. A morphometric anatomical study of the right coronary artery in Vietnamese. European Journal of anatomy. 2019;23(5):341–53.Nguyen VH, Talarico EF, Jr. A morphometric anatomical study of the right coronary artery in Vietnamese. European Journal of anatomy. 2019;23(5):341–53.Sun JL, Huang WM, Guo JH, Li XY, Ma XL, Wang CY. Relationship between myocardial bridging and coronary arteriosclerosis. Cell Biochemistry and Biophysics. 2013 Apr 1;65(3):485–9. doi: 10.1007/s12013-012-9438-ySun JL, Huang WM, Guo JH, Li XY, Ma XL, Wang CY. Relationship between myocardial bridging and coronary arteriosclerosis. Cell Biochemistry and Biophysics. 2013 Apr 1;65(3):485–9. doi: 10.1007/s12013-012-9438-ySwaroop N, Poornima GC, Shashanka MJ. Study of Myocardial Bridges in the Hearts of the Human Cadavers. Global Journal of Medical research. 2014;14(1): 24–8.Swaroop N, Poornima GC, Shashanka MJ. Study of Myocardial Bridges in the Hearts of the Human Cadavers. Global Journal of Medical research. 2014;14(1): 24–8.Teofilovski-Parapid G, Jankovic R, Kanjuh V, Virmani R, Danchin N, Prates N, et al. Myocardial bridges, neither rare nor isolated—Autopsy study. Annals of Anatomy - Anatomischer Anzeiger. 2017 Mar 1;210:25–31. doi: 10.1016/j.aanat.2016.09.007Teofilovski-Parapid G, Jankovic R, Kanjuh V, Virmani R, Danchin N, Prates N, et al. Myocardial bridges, neither rare nor isolated—Autopsy study. Annals of Anatomy - Anatomischer Anzeiger. 2017 Mar 1;210:25–31. doi: 10.1016/j.aanat.2016.09.007Watanabe Y, Arakawa T, Kageyama I, Aizawa Y, Kumaki K, Miki A, et al. Gross anatomical study on the human myocardial bridges with special reference to the spatial relationship among coronary arteries, cardiac veins, and autonomic nerves. Clinical Anatomy. 2015 Nov 17;29(3):333– 41. doi: 10.1002/ca.22662Watanabe Y, Arakawa T, Kageyama I, Aizawa Y, Kumaki K, Miki A, et al. Gross anatomical study on the human myocardial bridges with special reference to the spatial relationship among coronary arteries, cardiac veins, and autonomic nerves. Clinical Anatomy. 2015 Nov 17;29(3):333– 41. doi: 10.1002/ca.22662

The authors declare that there are no conflicts of interest present.