Anastomoses between bronchial and coronary circulation in a porcine model: computed tomographic and angiographic demonstration.

INTRODUCTION

Although the importance of the bronchial arteries is evident in modern day thoracic surgery, the significance of their communications with coronary arteries has yet to be appreciated, especially in cases of heart-lung transplantation and aortic aneurysm repair. We conducted a study to demonstrate the coronary-bronchial anastomotic routes in a porcine model using angiography and computed tomography.

METHODS

Six young female white pigs were used. The heart and lungs were removed en bloc, including the lower trachea and oesophagus. Digital subtraction angiography of the bronchial circulation and spiral computed tomography scan were performed in a three-phase study before and after administration of contrast medium. This was achieved by infusion either into the cannulated bronchial artery or into the aortic root. Macroscopic evaluation was carried out using latex infusion into the bronchial or coronary circulation.

RESULTS

We demonstrated communications between the bronchial and coronary systems in 5 of 6 subjects. This communication was located at the left atrial wall and the posterior and anterior wall of the left ventricle. In one case there were further anastomoses around the right atrial wall.

CONCLUSIONS

There were communications between the left coronary arteries and the bronchial arteries in the majority of cases. Digital subtraction angiography and spiral computer tomography scan can demonstrate these communications directly and indirectly by measurements of contrast enhancement within the heart wall. Our study emphasises the importance of the bronchial arteries in cases of heart-lung transplantation and repair of thoracic aortic aneurysms.