Clinical Pathologic Correlations in Coronary Artery Disease

T HE EXTENSIVE clinical utilization of coronary angiography and coronary artery surgery in recent years has heightened interest in the anatomy and pathology of the coronary arterial tree.Much new information has indeed been amassed concerning the patterns of distribution of the coronary arteries, the size and extent of interarterial coronary anastomoses, the nature, location, and extent of coronary artery narrowing and occlusion, and the correlation of these findings with pathologic changes in the myocardium and with clinical manifestations of coronary heart disease.Many years ago these matters were the subjects of extensive clinicopathologic studies based on the postmortem injection-plus-dissection technic developed by Schlesinger.'We are, therefore, interested here in reviewing these early findings as well as the recent observations and assessing their significance for the many difficult problems that arise in the clinical management of coronary artery disease today. AnastomosesThe most effective protection against the otherwise dire effects of coronary occlusions is afforded by the interarterial collateral circulation of the heart.In 1669 Lower described the development of anastomoses following arterial occlusion, but he did not state whether he had observed interarterial anastomoses in the coronary arteries of the normal heart.2In a prolonged controversy, anatomists have maintained that interarterial coronary connections