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By the employment of injection methods, it has been possible to demonstrate vascular communications between the coronary arteries and the chambers of the heart. Serial sections and wax-plate reconstructions of these communicating vessels revealed two types which have not been described previously. The first of these communicating vessels are small branches of arteries or arterioles lying near the endocardium. They run a short course and empty directly into the lumen of the heart and, for this reason, they have been referred to as “arterio-luminal” vessels. The second type of vessel arises as a branch of an artery or arteriole and soon breaks up into sinusoids which lie between the muscle bundles and at times between the individual muscle fibers. These vessels have been referred to as “arterio-sinusoidal” vessels, and the sinusoids have been designated as “myocardial sinusoids.”
The histological structure of the “myocardial sinusoids” would indicate that they play a rôle in the nourishment of the heart muscle.
Nouvelles découvertes sur le coeur, Paris
Disputatio medica de circulo sanguinis in corde, Lugduni Batavorum
De motu cordis et aneurysmatibus (opus postumum), Lugduni Batavorum
Phil. Trans. Royal Soc., 88 (1798), p. 103 London
Am. J. Physiol., 1 (1898), p. 86
J. Exper. Med., 47 (1928), p. 293
Trans. A. Am. Physicians, 44 (1929), p. 345
J. Clin. Investigation, 11 (1932), p. 823
Heart, 15 (1929), p. 103
J. Physiol., 73 (1931), p. 36
Heart, 13 (1926), p. 273
Arch. Int. Med., 51 (1933), p. 112
J. A. M. A., 81 (1923), p. 177
Proc. Boston Soc. Natural Hist., 29 (1900), p. 185
Virchow's Arch. path. Anat., 266 (1927), p. 647
J. Exper. Med., 56 (1932), p. 919
Am. Heart J., 5 (1930), p. 412
From the H. K. Cushing Laboratory of Experimental Medicine in the Department of Medicine of Western Reserve University School of Medicine and Lakeside Hospital, Cleveland, Ohio, and from the Thorndike Memorial Laboratory, Second and Fourth Medical Services (Harvard), Boston City Hospital and the Department of Medicine, Harvard Medical School.☆☆
The results reported in the first part of this paper (celloidin injection experiments) were carried out in 1928 while Dr. Mettier was working with me in the Thorndike Laboratory. The investigation has since been extended and completed in the H. K. Cushing Laboratory where Dr. Klumpp joined in the work. Miss Zschiesche assisted in the investigation throughout. J. T. W.★
The expenses of this investigation have been defrayed in part by a grant from the B. F. Bourne Memorial Fund of the Department of Medicine, Western Reserve University.
Copyright © 1933 Published by Mosby, Inc.
The existence of direct vascular communications between the coronary arteries and the
chambers of the heart has been claimed and denied. Such evidence as has been presented in favor
of the existence of these channels has been infirect and based largely upon experiments in which
perfusions and injections of the coronary vessels were employed. The use of the same general
methods variously modified has led others to deny the existence of channels bewteen the
coronary arteries and heart chambers. If such channels do exist they almost certainly play a role
in the circulation of the heart, but at present time there is no agreement as to the nature or the
importance of that role. It seemed wise, therefore, to study the vessels by injections and by the
rather tedious method of serial sections and wax-plate reconstructions in order to establish their
anatmical and histological structure. Such knowledge, if established, should be of definite value to
those investigators who, in studying the physiology of the coronary circulation, have been
compelled to make one of two assumptions; namely, that vascular channels between the coronary
arteries and the atria and vestricles either do or do not exist.
It is proposed to present here histological and other evidence of the existence of direct vascular channels between the coronary arteries and the chambers of the heart, as well as the results of certain observations upon the histological nature of these communicating vessels.
The belief that the coronary arteries have direct communications with the chambers of the heart is not a new one. The idea was first advanced by Raymond Vieussens in 1705 in a letter to Monsieur Boudin, Conseiller d'Etat, Premier Medicine de Monseigneur le Dauphin. Boudin's reply in which he acknolwedged receipt of Vieussens' letter was dated July 9, 1705. Vieussens' letter was published in 1706. In it he related how, in examining the depth of the roots of a large polyp which had formed in the right ventricle of the heart of a man who had died of a slower fever accompanied by violent palpitation of the heart, he traced the firmest roots of the clot as far as certain holes which seemed to him to to be the orifices of specific ducts. He made several similar observations and from them concluded that blood circulating in the medial and inner fleshy vessels of the heart was carried into the cavities by ducts in which the polyps first take root. Next he injected saffran dye, dissolved in spirits, into the left coronary artery and observed its passage into the left atrium and left ventricle, but none escaped via the veins into the right chambers. He called these communicating vessels "fleshy" ("le reste est pousse en partie dans le ventricule gauche de ce viscere par des vaisseaux, que j'appelerai charnus cy-apres"). Vieussens also dissected human hearts and the hearts of sheep and calves, and, with the aid of a microscope, found the small openings (ouvertures) in the chambers of all, in some instances with delicate valves over the openings while in others valves were lacking. He noted that many of the channels (conduits) received blood from several fleshy vessels. To these he gave the name "common vessels" and to their orifices the name "common openings" ("je les appelleray des vaisseaux communs: j'appelleray aussileurs embouchures des ouvertures communes").
These vessels and openings, so clearly described by Vieussens, have since been confused with somewhat similar ones described by Thebesius two years later in 1708, and as a result all such vessels are now commonly known as thebesian vesins. Thebesius injected certain substances into the coronary veins and noted their escape into the heart cavities through small openings in the endocardium. He was familiar with Vieussens' work and so states in his paper.
Thebesius' belief that the vessels were connected only with veins was supported by several anatomists of the day and Vieussens' work was soon forgotten. Lancisi in 1740 injected mercury into the coronary arteries and observed its apperance in the heart chambers, but believed with Thebesius that it escaped through venous channels (thebesian veins). In 1798 John Abernathy, by making a "common coarse waxen.
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Fig. 1.--Heart 10. A photograph of the same specimen shown in the painting in Plate I, Figs. 1 and 2.
Fig. 2.--Heart 9. A celloidin cast of the right ventricular chamber and the coronary arteries. It shows firm fusion of the tips of some of the arteries with the cast of the chamber
(See opposite page for explanation of Fig. 2)