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1、CHAPTER60ACQUIREDHEARTDISEASE:CORONARYINSUFFICIENCYRajaR.Gopaldas,DannyChu,andFaisalG.Bakaeenbehindthemainpulmonaryarterytrunkandthensplittingintocoronaryarteryanatomyandphysiologytheleftanteriordescending(LAD)andleftcircumflexarteries.historyofcoronaryarterybypasssurgeryTheLADcoursesinananterolat
2、eraldirectiontotheleftoftheatheroscleroticcoronaryarterydiseasepulmonarytrunkandrunsanteriorlyovertheinterventricularclinicalmanifestationsanddiagnosisofcoronaryseptum.ThediagonalbranchesoftheLADsupplytheantero-arterydiseaselateralwalloftheleftventricle.TheLADisconsideredthemostindicationsforcoron
3、aryarteryrevascularizationimportantsurgicalvesselbecauseitsuppliesmorethan50%ofadjunctstocabgtheleftventricularmassandmostoftheinterventricularseptum.postoperativecareTheLADhasseveralseptalperforatingbranchesthatsupplythealternativemethodsformyocardialrevascularizationinterventricularseptumfromthe
4、anterioraspect.TheLADextendsovertheinterventricularseptumuptotheapexofthereoperationforcoronaryarterydiseaseheart,whereitmayformananastomosiswiththeposteriormechanicalcomplicationsofcoronaryarterydiseasedescendingartery(PDA),whichistypicallyabranchoftherightcoronaryarterybypassgraftingandspecialpa
5、tientcoronarysystem(Fig.60-1).populationsThecircumflexarterypassesthroughtheatrioventriculargroove(AV)andfollowsaclockwisecourse.Wherethecircum-flexarterycoursesthroughtheAVgroove,itgivesoffbranchesinaperpendicularfashionthatextendtoward,butdonotquiteCardiovasculardiseaseistheleadingcauseofdeathin
6、theUnitedreach,theapexoftheheart.ThesebranchesaredesignatedtheStates.Coronaryarterydisease,whichisresponsibleformoreobtusemarginalbrachesandaredesignatednumericallyfromthan50%ofallcardiovasculardisease–relateddeaths,wasproximaltodistal.Thecircumflexcoronaryarteryusuallyter-expectedtoaccountformore
7、than$80billionindirectcostsinminatesastheleftposterolateralbranchaftertakingaperpen-2010.IntheUnitedStates,approximately1millionpeopledicularturntowardtheapex.sustainanacutemyocardialinfarction(MI)everyyearbecaus
