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The heart pumps out oxygen-rich blood through the aorta to nourish the entire body. It also supplies itself via a network of blood vessels called the coronary circulation. The two main vessels – the left and right coronary arteries – branch out from the aorta shortly after it exits the heart, right above the aortic valve.
The right coronary artery provides blood supply to the right atrium, and gives rise to:
– the marginal artery nourishing the lateral aspect of the right side of the heart,
– and the posterior interventricular artery, or posterior descending artery, supplying the posterior aspect of both ventricles and part of the interventricular septum.
The right coronary artery also supplies the SA node and AV node in the majority of people.
The left coronary artery splits into 2 major branches:
– the anterior interventricular artery, or anterior descending artery, supplying the anterior walls of both ventricles and most of the interventricular septum. This artery contributes the most to the left ventricle and is therefore the most critical vessel of the heart.
– the circumflex artery curves toward the posterior surface, providing for the left atrium and posterior walls of the left ventricle.
Coronary circulation is of utmost importance as it is required for normal function of the heart, which supplies blood to the entire body. A blocked coronary artery may cause life-threatening myocardial infarction, or heart attack. The most common cause of blockage is the accumulation of fat deposits on the wall of blood vessels, in a condition known as coronary heart disease.
Several procedures are available to treat coronary heart disease and restore normal blood supply to the heart. The most commonly performed are angioplasty and vascular bypass surgery.
Coronary angioplasty, also known as percutaneous coronary intervention, PCI, is a minimally invasive endovascular procedure used to widen narrowed or blocked coronary arteries. A deflated balloon attached to a catheter is passed through the femoral artery in the groin to the site of blockage, where the balloon is inflated, opening the artery. A stent may also be inserted together with the balloon and left in place to keep the artery open permanently. PCI is the procedure of choice for emergency treatment.
Coronary bypass, or vascular bypass, is a surgical procedure performed to create an alternative route for the blood to flow beyond the site of blockage. An artery graft from the patient’s chest, or a vein graft from the patient’s leg may be used for this purpose. Vascular bypass is usually performed in patients with severe coronary heart disease to prevent heart attacks, but it may also be used during or after a heart attack.