Key result
The proximal coronary arteries develop by growing into the aorta from the peritruncal ring of the subepicardial vascular plexus, rather than sprouting from the aortic root.
This review provides a comprehensive overview of the normal anatomy, variants, and embryological development of the coronary arteries, highlighting historical milestones in their study.
Anatomy of subepicardial coronary arteries became a topic of investigation at autopsy in Florence (Italy) by Banchi in the early twentieth century, with the discovery of dominant and balanced patterns. Thereafter, in the 60's of the same century Baroldi in Milan did post-mortem injection with spectacular three-dimensional casts. Later Sones at the Cleveland Clinic introduced selective coronary arteriography for in vivo visualization of coronary arteries. In the present chapter we show these patterns, as well as normal variants of origin and course with questionable risk of ischemia, like myocardial bridge as well as origin of the left circumflex coronary artery from the right sinus with retroaortic course. As far as embryology, the coronary arteries and veins are epicardial in origin and finally connect the former with the aorta, and the latter with the sinus venosus. At the time of spongy myocardium, intramural blood supply derives directly by the ventricular cavities, whereas later, at the time of myocardial compaction, vascularization originates from the subepicardial network. The connection of the subepicardial plexus with the aorta occurs with prongs of the peritruncal ring, which penetrate the facing aortic sinuses. Septation of truncus arteriosus is not responsible for the final position of the coronary orifices. Infact in transposition of the great arteries coronary ostia are regularly located within facing sinuses of the anterior aorta.
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Thiene et al. (2021) conducted a review in Coronary artery anatomy and embryology. The proximal coronary arteries develop by growing into the aorta from the peritruncal ring of the subepicardial vascular plexus, rather than sprouting from the aortic root.
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