The objective of this study was to analyse the correlation between aortic diameter,
heart size, and type of coronary circulation. The study was carried out
on 102 human hearts (59 male and 43 female). Casts of the vascular system of
each heart were prepared using epoxide resins. The hearts were measured for
their size and aorta diameter, and classified to a coronary circulation type. The
examination of materials indicated no significant correlation between aortic
diameter and sex or coronary circulation type. However, a statistically significant
correlation between aortic diameter and heart volume index was found.
Folia Morphol 2010; 69, 1: 30-3

Czerwiński, F.

Gawlikowska-Sroka, A.

Miklaszewska, D.

English

Via Medica Journals

Folia Morphol. Vol. 69, No. 1, pp. 30–34Copyright © 2010 Via MedicaISSN 0015–5659www.fm.viamedica.plO R I G I N A L    A R T I C L E30Address for correspondence: A. Gawlikowska-Sroka, Department of General and Clinical Anatomy, Pomeranian Medical University,Powstańców Wielkopolskich 72, 70–111 Szczecin, Poland, tel: +48 91 466 14 80, e-mail: gawlikow@sci.pam.szczecin.plAnalysis of the correlation betweenaortic diameter, heart size, and typeof coronary circulationA. Gawlikowska-Sroka, D. Miklaszewska, F. CzerwińskiDepartment of General and Clinical Anatomy, Pomeranian Medical University, Szczecin, Poland[Received 11 August 2009; Accepted 2 November 2009]The objective of this study was to analyse the correlation between aortic dia-meter, heart size, and type of coronary circulation. The study was carried outon 102 human hearts (59 male and 43 female). Casts of the vascular system ofeach heart were prepared using epoxide resins. The hearts were measured fortheir size and aorta diameter, and classified to a coronary circulation type. Theexamination of materials indicated no significant correlation between aorticdiameter and sex or coronary circulation type. However, a statistically signifi-cant correlation between aortic diameter and heart volume index was found.(Folia Morphol 2010; 69, 1: 30–34)Key words: aortic ostium, coronary circulation type, heart volume indexINTRODUCTIONThe increase in heart weight during postnataldevelopment is not proportionate to a child’s otherindividual traits [24, 26]. The largest heart mass in-creases occur during the first year of life and duringpuberty [20]. A Tabulae Biologicae monograph pub-lished in 1941 under the editorship of Krogman [in 20]provides a summary of data collected up to 1933on linear dimensions of the heart, its weight, andsurface of aortic and vein ostia in postnatal humandevelopment. Measurement results vary by age andsex and emphasize the differentiation by sex ob-served in the postnatal period. Wolański [in 20] stu-died children’s hearts from infancy and found thatthe weight of the heart in infants was about 20.0 g,increasing to 38.0 g in the first year of life, 51.5 g inthe second year of life, and attaining a weight char-acteristic for adults at approximately 18–20 yearsof life. The weight of the heart in adult humans var-ies and ranges between 300 and 400 g [17]. Con-siderable differences are observed in heart weightbetween male and female individuals in the sameage groups, with the male’s heart weight beinggreater by about 10–20 g. In addition, measurementresults for heart length and width are greater in malethan in female individuals [9, 13, 20]. Sexual dimor-phism reflected in the size of the human heart isobserved early in the foetal period [20]. During on-togenesis the shape of the heart also changes fromround in the foetal period to an oblong in adult in-dividuals [20]. Wolański [in 20] studied the correla-tion between the width and length of the heart andfound it to be 1.3 in newborns and only 1.08 in chil-dren aged 11. Other authors do not provide dataon the correlation between sex and heart size andweight [20]. However, it is known that the propor-tion between heart weight and body mass is cer-tainly greater in the foetus than in children (in new-borns 0.73–0.77%) or adults (0.57–0.58%). Theweight and size of the heart may change in adultsover their lifespan depending on various factors [25].Most frequently, it results from pathological hyper-trophy of the cardiac muscle, but heart weight mayalso increase after intense physical activity. Zandri-31A. Gawlikowska-Sroka et al., Aortic diameter and type of coronary circulationno [30] described the hearts of athletes, whoseweight was greater than the control group, and theweight increase was correlated with the develop-ment of the left coronary artery trunk and the ante-rior interventricular branch. This raises an interest-ing question: whether hearts of greater dimensionsalso have greater aortic diameter, and whether thisdiameter is correlated with the coronary circulationtype. The objective of this study was to find an an-swer to these questions.MATERIAL AND METHODSThe study was carried out on 102 human hearts,of which 59 were male and 43 female, dissectedfrom patients aged between 12 and 70, deceasedfor non-cardiac causes. Only hearts without appar-ent morphological lesions within the heart muscleand coronary vessels were qualified for the study.The study material was derived from the collectionof the Department and Institute of Normal Anato-my of the Pomeranian Medical University.The coronary vessels of the examined hearts andthe ascending aorta were filled with epoxide resinPolimal 100, Polimal 150, and Duracryl resin, whichhave a low coefficient of shrinking (6%). Duracryl,owing to its consistency, allowed the filling of evenvery small branches of the coronary vessels. The res-in was mixed with appropriate pigments: red forarteries and blue for veins. The epoxide resin wasdissolved in a solvent, with added hardening agentand pigment [3]. When the resin attained the con-sistency of honey it was injected via the aorta intothe coronary vessels under a constant pressure of120 mm Hg.Afterwards, under the same pressure, the heartchambers were filled: the left ventricle and left atri-um via the aorta (after ligation of the pulmonaryveins), and the right atrium and right ventricle viathe superior vena cava (after closure of outflow viathe inferior vena cava and the pulmonary trunk). Theprepared specimens were immersed in glycerol for24 hours, which allowed the preservation of the na-tural shape of the heart and coronary vessels. For thetime of preservation, the hearts were suspended bylarge vessels in order to avoid any contact with hardsurfaces which might have resulted in deformation.After the resin’s solidification, the hearts were im-mersed in 40% hydrochloric acid to break down softtissues. Consequently, true casts of the hearts andall coronary vessels were obtained (Figs. 1, 2).The following measurements were performed:heart depth (SGL) — the largest sagittal dimensionof the heart, heart length (SDL) — the largest longi-tudinal dimension from the apex of the heart to theplane adjacent to the base of the heart, and heartwidth (SSZ) — the largest diagonal dimension ofthe heart. The diameter of the aorta was measuredat the level above the divergence point of the leftcoronary artery (Fig. 3).Heart measurements were performed usinga breadth calliper, with an accuracy of 1 mm. TypesFigure 1. Specimen of the heart — anterior view.Figure 2. Specimen of the aorta — superior view.32Folia Morphol., 2010, Vol. 69, No. 1of coronary circulation were evaluated based on theclassification established by Hettler [11].Afterwards, the heart volume index was calcu-lated as the ratio of heart length, depth, and width.The correlation between heart size and the type ofcoronary circulation was analysed using Pearson’scorrelation matrices. Further analyses involvedKruskal-Wallis’s non-parametric ANOVA and UMann-Whitney’s tests. Statistical significance wasobserved at p < 0.05.RESULTSThe aortic diameter was larger in male hearts, onaverage, by 0.5 mm, in comparison with femalehearts. This difference was not statistically significant(Table 1).The aortic diameter was comparable in groupswith different coronary circulation types (Table 2).Differences in aortic diameter between the studiedgroups were not statistically significant. The exami-nation of materials indicated no significant correla-tion between aortic diameter and sex or coronarycirculation type. Analysis demonstrated a statisti-cally significant correlation between aortic diame-ter and heart volume index (p £ 0.016). In smallerhearts (HVOL £ median) the aortic diameter waslarger and amounted, on average, to 27 ± 2.2 mm,while in larger hearts (HVOL > median) it was lowerand amounted, on average, to 26 ± 3.5 mm.DISCUSSIONThere is an extensive amount of medical publi-cations on coronary vessels. In the available litera-ture the correlation between coronary vessels andother factors is most frequently analysed with refer-ence to heart weight [6, 7, 30]. Currently, owing tothe development of imaging techniques offeringa 3D heart image, the analysis is based on heart vo-lume parameters. Therefore, in this study the heartvolume index was used as an indicator of its size.The heart volume index was previously used in stud-ies on foetal hearts by Nowak and Bożiłow [21]. Theydemonstrated the high significance of this factor forthe evaluation of heart size increase. This study con-firmed the difference in heart size depending on sex,and confirmed that male hearts are larger than femaleones. However, the differences were not statisticallysignificant. Similar conclusions were presented byNowak [20], who reported that initially in the foetalperiod “the arithmetical values of heart dimensionsare higher in female individuals, but in the last trimes-Figure 3. Scheme of aorta diameter measurement (AOS).Table 1. Results from measurement of aortic diameter by sexParameter Mean [mm] Minimum [mm] Maximum [mm] Standard deviationT F M T F M T F M T F MAortic diameter 26.3 25.9 26.5 17 17 19 35 35 32 3.0 3.3 2.8T — total; M — male hearts, F — female heartsTable 2. Results from measurement of aortic diameter by coronary circulation typeParameter Mean [mm] Minimum [mm] Maximum [mm] Standard deviationM L R M L R M L R M L RAortic diameter 26.5 25.3 26.1 19 17 20 35 29 32 3.0 3.7 2.7M — mixed (co-dominant) type of coronary circulation, L — left-dominant, dominance of the left coronary artery, R — right-dominant, dominance of the right coronary artery33A. Gawlikowska-Sroka et al., Aortic diameter and type of coronary circulationter differences tend towards higher values in malehearts”. Similarly, Chrobot [6] and Chrobot et al. [7]reported that sexual dimorphism in heart size is poor-ly pronounced and is not statistically significant in themajority of cases.The literature provides many classification methodsregarding coronary circulation type [2, 5, 8–11, 14–16,19, 22, 27, 29]. Most frequently, there are three types:with dominance of the right artery, with dominance ofthe left artery, and the co-dominant circulation type[1, 10, 16]. Most classification methods are based onthe course of the main vascular trunks and their branch-es. Vasko [28] analysed types of coronary circulationusing the perfusion technique. However, this type ofclassification is very rarely used. This study applied theclassification criteria established by Hettler [11], whichare clear, easy to interpret, and are based on the courseof interventricular branches and the analysis of the rangeof areas supplied by them. The findings from this studyindicate that the co-dominant coronary circulation typewas prevalent. Similar results were obtained by Adachi[2], Banchi [4], Paulin [23], and Hettler [11].There are very few publications on the size ofthe aorta and its correlation with coronary vessels.The measurement of the aortic ostium itself is diffi-cult, owing to its fluctuation over the cardiac cycle[1, 12]. The aortic opening is the widest, and imagequality is best 50–100 ms after the R peak using mul-tidetector computed tomography [1]. Chrobot [6], whostudied the development of large vessels during thefoetal period, observed a larger aortic diameter in thefemale foetus. Marek [18], in his study on the cause ofsudden death, reported that lower aortic diameter wasone of the features frequently detected in a group ofsuddenly deceased individuals without atherosclero-tic lesions within coronary vessels [18]. Based on thecarried out study, no correlation between aortic diam-eter and type of coronary circulation or sex was ob-served. However, a statistically significant correlationbetween aortic diameter and heart volume index wasfound. The aortic diameter was larger in small sizehearts and vice versa.REFERENCES1. Abbara S, Pena AJ, Maurovich-Horvat P, Butler J,Sosnovik DE, Lembcke A, Cury RC, Hoffmann U, Feren-cik M, Brady TJ (2007) Feasibility and optimization ofaortic valve planimetry with MDCT. Am J Roentgenol,188: 356–360.2. Adachi B (1928) Das Arteriensystem der Japaner.Kaiserlich-Japanische Universität, Kyoto.3. Aleksandrowicz R, Łoziński J (1959) Metoda stosowa-nia żywic poliestrowych do sporządzania preparatówi badań anatomicznych. Folia Morphol, 4: 445–449.4. Banchi A (1904) Morfologia della arteriae coronariaecordis. Arch Ital Anat Embrion, 3: 87.5. Cadermatiri F, La Grutta L, Malago R, Alberghina F,Meijboom WB, Pugliese F, Maffei E, Palumbo AA,Aldrovandi A, Fusaro M, Brambilla V, Coruzzi P, Midiri M,Mollet NR, Krestin GP (2008) Prevalence of anatomicalvariants and coronary anomalie in 543 consecutive pa-tients studied with 64-slice CT coronary angiography.Eur Radiol, 18: 781–791.6. Chrobot A (1995) Badania biometryczne serca i dużychnaczyń tętniczych w rozwoju   prenatalnym człowieka.Praca doktorska. Akademia Medyczna, Bydgoszcz.7. Chrobot A, Bożiłow W, Czerwonka-Szaflarska M,Swincow G (1996) Badania Biometryczne serca i dużychnaczyń tętniczych w rozwoju prenatalnym człowieka.Przegl Antropol, 59: 147–153.8. Di Dio LJ, Wakefield T (1975) Coronary arterial predo-minance or balance on the surface of the human cardi-ac ventricles. Anat Anz, 137: 147–158.9. Ford LE (1976) Heart size. Circ Res, 39: 297–303.10. Hazama S, Sakamoto I, Yamachika S, Ariyoshi T, Takai H,Eishi K (2005) Endovascular surgery using an originaloccluder for patent ductus arteriosus in an adult pa-tient. Jpn J Thorac Cardiovasc Surg, 53: 58–61.11. Hettler MG (1966) Zur normalen und pathologischenAnatomie der Koronararterienver sorgung des Herzensim intravitalen Angiogramm. Fortschr Geb RontgenstrNuclearmed, 105: 480–502.12. Hsu JH, Wu DK, Chen YF, Dai ZK, Lee MH, Wu JR (2007)Virtual intraluminal evaluation of aortico-left ventricu-lar tunnel by multislice computed tomography. Int JCardiol, 116: 266–268.13. Hutchins G, Bulkley B, Miner M, Boitnott J (1977)Correlation of age and heart weight  tortuosity andcaliber of normal coronary arteries. Am Heart J, 94:196–202.14. Karaca M, Kirilmaz A, Oncel G, Oncel D, Yilmaz H,Tamci B, Gurcay B (2007) Contrast-enhanced 64-slicecomputed tomography in detection and evaluation ofanomalous coronary arteries. Tohoku J Exp Med, 213:249–259.15. Kubica E, Sośnierz M (1964) Angiogramy wieńcowe60 przypadków sekcyjnych. Kardiol Pol, 7: 25–32.16. Lee WJ Segmental anatomy of coronary arteries. Radio-logy, 244: 319.17. Leung WH, Stadius ML, Alderman EL (1991) Determi-nation of normal coronary artery dimension in humans.Circulation, 84: 2294–2306.18. Marek Z (1962) Znaczenie miażdżycy tętnic wieńco-wych serca jako przyczyny śmierci. Folia Medica Craco-viensia, 4: 337–383.19. Neratzis CE, Papadristos JC, Gribzi JE, Voudris VA,Infantis GP, Koroxemidis GT (1996) Functional domi-nance of the right coronary artery: incidence in thehuman heart. Clin Anat, 9: 10–13.20. Nowak D (1998) Badanie anatomiczno-typologicznei biometryczne układu naczyniowego serca w prena-talnym rozwoju osobniczym człowieka. Praca doktor-ska. Akademia Medyczna, Bydgoszcz.34Folia Morphol., 2010, Vol. 69, No. 121. Nowak D, Bożiłow W (2003) Dimension of circumflexbranch according to type of heart vascularisation infoetal life of human. Folia Morphol, 62: 61–63.22. Osemlak J (1975) Zmienność rozwojowa tętnic wień-cowych serca człowieka. Pol Tyg Lek, 1: 1453–1454.23. Paulin S (1964) Coronary angiography. A technical,anatomic and clinical study. Actaradiol Stockh Suppl, 233.24. Schlant RC, Alexander RW (1940) The heart. Mc Graw--Hill, INC, New York.25. Schlesinger MJ (1940) Relation of anatomic pattern topathologic conditions of the coronary arteries. ArchPathol, 30: 403–415.26. Schulz DM, Giordano DA (1962) Hearts of infants andchildren. Arch Path, 72: 464–471.27. Spindola-Franco H, Grose R, Solomon N (1983) Dualleft anterior descending coronary artery: angiographicdescription of important variants and surgical implica-tions, Am Heart J, 105: 445–455.28. Vasko JS, Gutelins J, Sabiston DC Jr (1961) A study ofpredominance of human  coronary arteries determinedby arteriographic perfusion techniques. Am J Cardiol,8: 379.29. Vieweg WV, Alpert JS, Hagan AD (1975) Origin of thesinoatrial node atrioventricular node arteries in right,mixed, and left inferior emphasis systems. Cathet Car-diovasc Diagn, 1: 361–373.30. Zandrino F, Molinari G, Smeraldi A, Odaglia G,Masperone M, Sardanelli F (2000) Magnetic resonanceimaging of athlete’s heart: myocardial mass, left ven-tricular function and cross — sectional area of the cor-onary arteries. Eur Radiol, 10: 319–325.

Analysis of the correlation between aortic diameter, heart size, and type of coronary circulation

https://journals.viamedica.pl/folia_morphologica/article/download/15890/12528

Analysis of the correlation between aortic diameter, heart size, and type of coronary circulation

Abstract

Similar works

Full text

Available Versions

Via Medica Journals