Surgical Anatomy of the Coronary Artery Distribution

DURING the initial phases in the development of open-heart surgery, problems related to the perfusion procedure were common causes of morbidity and mortality. With improved perfusion technics and increased knowledge of the physiology of cardiopulmonary bypass, such problems have become less frequent. Now that the perfusion procedure itself is accomplished with considerable safety, the surgical anatomy of congenital cardiac malformations has assumed increasing importance. The gross anatomic features of various cardiac deformities were elucidated largely before the advent of open-heart surgery, and the pertinent anatomy of the cardiac conduction system has been the subject of several recent studies.1'5 The coronary artery distribution in congenital heart disease has received scant attention,6 although recent reports attest to the importance of anomalies of coronary circulation encountered during open-heart surgery.7-9 The present report deals with distribution of the coronary arteries in congenital heart disease, with emphasis on the two areas most frequently attacked during open-heart surgery: the right ventricular outflow tract and the region surrounding septal defects.