A Triad of Intricacies: An Exploration of Concomitant Codominant Coronary Artery Pattern, Patent Foramen Ovale, and Chiari Network in a Cadaveric Study

Abstract

Although findings related to codominant coronary artery circulation, patent foramen ovale (PFO), and Chiari network (CN) have been documented in isolation, there is a gap in literature detailing the unique case with the presence of all three cardiac anomalies concomitantly present in a single heart. The purpose of this case report is to detail a unique cadaveric heart case, to serve as reference to provide useful data for interventionalists and clinicians. This observational cadaveric study assessed a single donor heart obtained through the University of Houston College of Medicine's Willed Donor Program. After meticulous dissection, relevant heart surface structures were isolated and identified. Morphometric analysis and measurements were obtained via a digital vernier caliper. The donor heart exhibited a typical codominant coronary arterial scheme, in that the posterior interventricular artery arose as a merger between the right coronary and the circumflex on the postero-inferior surface of the heart when placed in the valentine orientation. Interestingly, the antero-lateral surface of the heart was supplied via a left marginal artery (LMA) and an accessory left anterior interventricular artery.Contribution to the existing knowledge base of unique concomitant cardiac anomalies, may prove to be a beneficial future reference for interventionalists in hopes that an expanded knowledge base may lead to comprehensive and safe implementation of a wide variety of procedures.

Keywords: cadaver case report; cadaveric study; cardiac anatomy; chiari network; codominant coronary artery circulation; concomitant cardiac anomalies; coronary artery anomaly; patent foramen ovale; patent foramen ovalis; pathologic anatomy.

Figure 1. Coronary Artery

A: Anterosuperior view of the heart illustrating coronary artery branching pattern. B: Anterior overview of the heart illustrating vasculature patterns C: Posterior view of the heart illustrating codominate PDA branching pattern AA: Ascending Aorta; RCA: Right Coronary Artery; LCx: Left Circumflex Artery; LMA: Left Marginal Artery; LAD: Left Anterior Descending; LAur: Left Auricle; LB: Limbus; PA: Pulmonary Artery; PDA: Posterior Descending Artery

Figure 2. Foramen Ovale

A: Superolateral view looking into the RA. Major landmarks are labeled. B: Superior view displaying a probe passing through the PFO shunt within the RA and emerging through its orifice in the LA C: Superior Anterolateral view of the LA displaying the approximate plane of measurements for the vertical diameter and the transverse diameter. CN: Chiari Network; ER: Eustachian Ridge; IAS: Interatrial Septum; IVC: Inferior Vena Cava; LAur: Left Auricle; LA: Left Atrium; LB: Limbus; MV: Mitral Valve; PFO: Patent Foramen Ovale; PFOSh: Patent Foramen Ovale Shunt; RA: Right Atrium; SVC: Superior Vena Cava; TDi: Transverse Diameter; VDi: Vertical Diameter

Figure 3. Chiari Network

A: Interior of RA showing the opening of the FO, ER, and the CN are indicated by white arrows B: Superior-Inferior View of the RA showing the CN. A probe is traversing the IVC (white arrows). The CN is the filamentous structure traversing the RA. C: The CN is shown with fine strands connected to the walls of the vena cava. The network overlays the IVC lateral to the entrance to the FO. CN: Chiari Network; CS: Coronary Sinus; ER: Eustachian Ridge; FO: Foramen Ovale; IVC: Inferior Vena Cava; RA: Right Atrium; SVC: Superior Vena Cava; TV: Tricuspid Valve