Angiographie Demonstration of Extracardial Anastomoses to the Coronary Arteries

In the last seven to eight years coronary angiography has become a clinically important method for studying the anatomy of and, to a certain extent, the flow in the coronary arteries. Several methods of coronary angiography have been described (Lehman 1959, Gensini 1963). In all, the efforts have been concentrated on delineating the anatomy of the coronary arteries and on showing anastomoses between them. There are potential anastomoses, however, from the bronchial arteries to the coronary arteries as shown by Voss in 1856, later by Robertson in 1930, and others. That these anastomotic channels may function in patients with coronary artery disease was demonstrated by Arvidsson and Moberg in 1963. In the reports published on coronary arteriography these collaterals have received no attention. They may have a diameter of over 2 mm (Fig. 1), however, and this is a size comparable to the internal mammary artery shown to be patent after implantation into the myocardium to improve the myocardial blood-flow (Björk and Björk, 1966; Sewell and others, 1965). In the postoperative evaluation of such patients the presence of collaterals between the bronchial arteries and the coronary arteries would be of great importance. Also, the assessment of patients with coronary artery disease in general would benefit from the demonstration of such channels. It was considered of interest, therefore, to investigate how often these collaterals could be seen in patients studied with our present technics of coronary angiography. Material The material consists of 221 patients in whom coronary angiography was performed. The indications for the procedure varied. A little less than half suffered angina pectoris, and the coronary angiograms were obtained to select candidates for surgery. In a smaller group of patients coronary angiography was performed to exclude coronary artery disease. In the remaining cases coronary angiograms were obtained mainly to evaluate the possibility of cannulating the coronary arteries during open heart surgery. Technic A gray Ödman-Ledin catheter with end-and side-holes was introduced percutaneously through the femoral artery. The tip was placed in the noncoronary sinus in the root of the aorta. The patients were placed prone in a left anterior oblique position on an Elema-Schönander biplane roll-ilm changer. They were given 0.5 mg nitroglycerine sublingually immediately before the injection of the contrast medium. General anesthesia or increased intrabronchial pressure was not employed. Approximately 1 ml/kg of body weight of Urografin 76 per cent or Isopaque 60 per cent was injected. The injection time was approximately two seconds. The injection was triggered by an electrocardiogram to start at the beginning of diastole. High-output roentgen tubes with a focus of 0.6 mm were used. The film-focus distance was usually 80 cm, with exposure factors of 800 mA, 0.01–0.04 seconds, and 65–85 kV.