Houyel L, Planché C
Service de chirurgie des cardiopathies congénitales, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson.
Arch Mal Coeur Vaiss. 2002 May;95(5):500-6.
Among the coronary trajectory anomalies found not only in congenital cardiopathies but also in otherwise normal hearts, the terms intramural and interarterial are still used in an ambiguous fashion too frequently. Study of the embryonic development of the coronaries allows a better understanding of the possibility of such a trajectory, (existence of the periarterial sheath). Certain anatomical factors favour the existence of an intramural coronary trajectory, the coronary always being tangential to the aorta in this case: paracommissural ostium, ostium situated too high, departure of the coronary at an acute angle, and ostium in the form of a slit. However, interarterial and intramural are not synonyms. In the case of a coronary trajectory tangential to the aorta, three anatomical and histological situations are possible: free trajectory, with the aorta and the coronary each having its own media and its own adventitia; adherent trajectory, with two separate media covered by a common adventitia: and true intramural trajectory, with fusion of the media without interposition of adventitia. These three situations have different surgical implications in the case of coronary reposition.
在不仅先天性心脏病而且其他方面正常的心脏中发现的冠状动脉走行异常中，壁内和动脉间这两个术语仍过于频繁地以模糊的方式使用。对冠状动脉胚胎发育的研究有助于更好地理解这种走行（动脉周围鞘的存在）的可能性。某些解剖学因素有利于壁内冠状动脉走行的存在，在这种情况下冠状动脉总是与主动脉相切：旁 commissural 开口、位置过高的开口、冠状动脉以锐角发出以及呈裂隙状的开口。然而，动脉间和壁内并非同义词。在冠状动脉走行与主动脉相切的情况下，有三种解剖学和组织学情况是可能的：自由走行，主动脉和冠状动脉各有自己的中膜和外膜；附着走行，有两个分开的中膜被共同的外膜覆盖；以及真正的壁内走行，中膜融合且无外膜介入。在冠状动脉重新定位的情况下，这三种情况具有不同的手术意义。
