Tortuosity of Coronary Arteries and Ishemic Heart Disease

Lebedeva E. O., Pliska A. I., Bruanskiy N. N., Pliska O. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

This article is devoted to the study of the relationship between the phenomenon of tortuosity of the coronary arteries and ishemic heart disease. Although the role of tortuosity of coronary arteries in the development of ischemic myocardial damage is not proven, that shouldn’t determine the strategy of prevention and treatment of this anomaly. This was the aim of our study. In order to realize the objectives of the study we performed a retrospective analysis of our database of patients with ischemic heart disease, caused by tortuosity of coronary arteries, which were examined and treated in SI “Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine”. 1776 patients were included in this study (1352 males, 424 females; mean age 57 ± 7,73 years). Most often in our data ischemic heart disease affects male patients in the age range 51­60 years, which is in agreement with data from the literature. Patients were divided into 4 groups according to the results of coronary angiography, the presence of tortuosity and atherosclerotic lesions of coronary arteries, and the degree of coronary atherosclerosis. According to the coronary angiography, 33 % of patients were identified as having tortuosity of the coronary arteries. Detailed analysis of tortuosity of the coronary arteries was then performed. Tortuosity in intact coronary arteries was most common in women. Tortuosity affected two vessels and was localized, both in women and men, in the left anterior descending artery and in the circumflex artery. Analysis of patients with tortuosity and atherosclerotic lesion of the coronary artery showed that the occurrence of atherosclerotic plaques is not dependant on gender. This analysis also showed the appearance of three vascular tortuosities of the coronary arteries. Patients with tortuous coronary arteries dominated the right type of coronary myocardial perfusion with tortuosity of left anterior descending artery and the circumflex artery, as well as three coronary arteries. Data analysis of the clinical picture of the groups suggested that in addition to the tortuosity of the coronary artery, atherosclerosis increases the degree of angina and the number of myocardial infarctions. Analysis of the literature shows that tortuosity of the coronary arteries may be an additional factor in the formation of atherosclerotic plaques. Regarding this issue it was revealed that a big interest was the study of the prevalence of atherosclerosis in tortuous and straight coronary arteries, which could possibly give indirect information regarding this issue. In some cases it was revealed that tortuosity of the coronary arteries is a separate and additional burdening factor in the development of ischemic heart disease. In 24 % of patients (60 pers.) with intact coronary arteries tortuosity led to the development of myocardial infarction, which determines the necessity to revise the views on the tactics of treating these patients. Straight coronary arteries were more affected by atherosclerosis than tortuous coronary arteries (65 % and 45 % respectively).

tortuous coronary arteries, myocardial ischemia, ischemic heart disease

• Воеводин а. Ф. Метод расчета нестационарных течений вязкой несжимаемой жидкости в переменных вихрь­функциях тока / а. Ф. Воеводин, г. е. долбин // Фундаментальные и прикладные проблемы современной механики : доклады 3­й Всероссийской научной конференции. – 2003.
• коваленко В. М. регіональні особливості рівня здоров’я народу україни / В. М. коваленко, В. М. корнацький // аналітично­статистичний посібник. – к., 2011. – с. 36.
• покровский а. В. что могут сегодня сосудистые хирурги: 50 лекций по хирургии / а. В. покровский. – М.: Media­ Medica, 2003. – с. 37.
• ройтберг г. е. Внутренние болезни. сердечно­сосудистая система / г. е. ройтберг, а. В. струтинский. – М.: бином, 2007. – с. 236.
• скобцов Ю. а. Моделирование и визуализация поведения потоков крови при патологических процессах / Ю. а. скоб­ цов, Ю. В. родин, В. с. оверко. – донецк : издатель а. Ю. заславский, 2008. – с. 51, 55.
• Coronary Artery Loops and Myocardial Ischemia / F. Barilla, F. Romeo, G. Rosano [et al.] // Am. Heart J. – 1991. – Vol. 122. – P. 225­226.
• Coronary tortuosity: a long and winding road / E. S. Zegers, B. T. J. Meursing, E. B. Zegers, A. J. M. Oude Ophuis // Neth. Heart. J. – 2007. – Vol. 15. – P. 191­195.
• Severe coronary tortuosity and the relationship to significant coronary artery disease / S. S. Groves, A. C. Jain, B. E. Warden [et al.] // W. V. Med. J. – 2009. – Vol. 105, № 4. – P. 14­17.
• The influence of the non – Newtonian properties of blood on the flow in large arteries: unsteady flow in a 90 degrees curved tube / F. J. Gijsen, E. Allanic, F. N. van de Vosse [et al.] // J. Biomech. – 1999. – Vol. 32. – P. 705­713.
• Waller B. F. Nonatherosclerotic coronary heart disease // The Heart / S. W. Hurst, ed. – New York : McGraw­Hill, 1994. – P. 1239­1261.
• Yang Li. Clinical Implication of Coronary Tortuosity in Patients with Coronary Artery Disease [електронний ресурс] / Yang Li, Chengxing Shen, Yanan Ji // PLoS ONE. – 2011. – Vol. 6, № 8. – режим доступу : http://www. ncbi. nlm. nih. gov/pmc/ articles/PMC3164184/.

«Bulletin of problems biology and medicine» Issue 3 part 2 (111), 2014 year, 161-167 pages, index UDK 616. 127­005. 4:616. 132. 2­007. 2]­71