Corelațiile morfo-clinice ale ramurilor arterelor coronare și traiectului lor intramural
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StatusThe thesis was presented on the 25 February, 2022Approved by NCAA on the 1 July, 2022 Abstract – 0.98 Mb / in romanian – 0.98 Mb / in romanianThesisCZU 616.132.2-007-053.1:616.127(043.2)
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Summary
The purpose of the research. Evaluation of morpho-functional features of variants of atypical intramural trajectory of coronary arteries.
Objectives:
- Study of the individual anatomical variability of large subepicardial coronary arteries highlighting the atypical intramural trajectory variants;
- Establishment of the segments of the coronary arteries with predisposition to atherosclerotic lesions and determination of the correlation with the variants of the atypical intramural trajectory of the coronary arteries;
- Evaluation of the morphological aspects of the variants of the intramural trajectory of the subepicardial coronary arteries, especially of the myocardial bridges;
- Determination of the angiographic and functional features of the variants of the intramural trajectory of the coronary arteries;
- Argumentation of the role of the morphological substrate of the variants of the intramural trajectory of the coronary arteries in the occurrence of myocardial ischemia. Scientific novelty of the research
A morpho-functional study was performed with the purpose to analyse the epidemiological and morpho-functional aspects of the variants of the atypical intramural trajectory of the coronary arteries. The current research presents an attempt to assess the individual anatomical variability of the heart arteries, the correlation between variants of the intramural trajectory and coronary atherosclerosis, some features of the intramural coronary trajectory, including: the anatomical incidence, preferential location, association with other coronary and cardiac variants, peculiarities of structure and arrangement of the myocardial bridges, characteristic of the under the bridge perivascular space, structure of proximal-, under- and distal the bridge arterial portions, aspects of the trajectory of the perivascular nerve bundles in the intramural portion.
We have proposed our own classification of the variants of the intramural trajectory of the coronary arteries. The intramural trajectory variants were analysed complexly, at macroscopic, macro/micro- and microscopic level. The obtained data were compared with the data of functional evaluations, which allowed to assume why not all myocardial bridges are clinically manifested and what is their impact on coronary circulation.
Theoretical importance
The results of the current research allowed the epidemiological assessment of the variability of coronary arteries, the incidence and degree of coronary atherosclerotic lesion, the incidence, and types of variants of the intramural trajectory of heart arteries in the population of the Republic of Moldova.
The obtained data are the result of the multi-aspectual, morphological, and functional approach to the variants of the coronary intramural trajectory and facilitate the highlighting of the morphological and pathophysiological determinants in the case of the variants of the intramural trajectory of the coronary arteries. During the study of the variants of the intramural trajectory of the coronary arteries, were determined the potential structural features with ischemic and anti-ischemic coronary effect.
The obtained results of the study give an accumulation of sufficient knowledge to differentiate the typical and atypical variants of the intramural trajectory of the coronary arteries, positioning some of them in the category of structures that can influence the myocardial perfusion.
The applicative value of thesis
Identifying the role of variants of the intramural trajectory of the coronary arteries allows the positioning of the myocardial bridges in the category of structures that, at a certain stage and having a certain morphological parameter, can damage the myocardial perfusion. The results of the study encourage the use of classical macroscopic and macro-micro- as well as microscopic methods in determining the morphological features of myocardial bridges. Among the multiple morphological features found out within the study is the identification of structural features with ischemic and anti-ischemic effects of myocardial bridges.
Determination of variants of origin, trajectory, size of coronary arteries and their branches allows safe handling of medical devices during endovascular procedures on the arteries of the heart.
The obtained results made it possible to create a clear image regarding the possible ischemic role of the variants of the intramural trajectory depending on the topography and the degree of coronary systolic compression.
The approached topic made possible the differentiation of the coronary variants of atypical and typical intramural trajectory.
Implementation of scientific results
The study of the morphological and morpho-clinical aspects of the intramural trajectory of the coronary arteries was initiated and started in 2007 within the primary university cycle of medical training.
The morphological peculiarities of the intramural trajectory of the coronary arteries were presented in 2011 within the license thesis carried out at the Department of Human Anatomy and entitled as Morpho-clinical features of the intramural trajectory of the coronary arteries.
Subsequently, in 2015, within the thesis of Master of Human anatomy: Peculiarities of branching and structure of large coronary arteries and their correlation with atherosclerotic lesions, were presented data of the variants of coronary arteries, the association of the coronary artery variants with those of the intramural coronary trajectory.
At the same time, the scientific data, obtained in the period of 2007-2019 were generated by the research activity within two scientific research projects: national project for young researchers of Morphology of myocardial bridges and it’s clinical correlations, during the years 2012-2013, and bilateral international research project 2015-2016, carried out in partnership with Grodno Medical University, Republic of Belarus – Morpho-clinical aspects of the valvular apparatus of the heart and large coronary arteries.
The results of the current study are used in the scientific-didactic process of the Department of Anatomy and Clinical Anatomy of State University of Medicine and Pharmacy “Nicolae Testemitanu” and in the scientific activity of the Centralized Pathological Anatomy Department within the Public Medical-Sanitary Institution for Scientific Research in Maternal and Child Health Care.
Oficial Reviewers
- Natalia Trushel
doctor habilitat, professor - Serghei Suman
doctor habilitat, associate professor (docent) - Irina-Draga Căruntu
doctor, professor
Council's Members
- Fulga Veaceslav, president
doctor habilitat, associate professor (docent) - Ilia Catereniuc,
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova - Valeriu Revenco,
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova - Viorel Nacu,
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Theses
