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J. Morphol. Sci., 2011, vol. 28, no. 4, p. 300-302300

Short

communication

The AMA study (Multi-Arterial Atherosclerosis): correlation ofmalformation of cardiac and cerebral arteries

Nordon, DG.*, Guimares, RR., Camargo Neto, AA. and Rodrigues Junior, OF.

Departamento de Medicina, Faculdade de Cincias Mdicas e da Sade de Sorocaba,Ponticia Universidade Catlica de So Paulo PUC, Sorocaba, SP, Brazil*E-mail: d-nordon@uol.com.br

Abstract

We are perorming a study on the distribution o atherosclerosis in the arteries and during our dissectionswe have ound arterial malormations in the brain and heart. O these, 6 are related to the posterior cerebralarteries and 3 are related to the posterior Interventricular artery o the heart. In all these three cases, suchaorementioned abnormality in the circle o Willis also occurred. It is an interesting and unexpected fndingand we are still waiting or urther development in our work in order to clariy these related malormations.

Keywords: arterial malormation, atherosclerosis, posterior cerebral artery, posterior cerebral circulation,posterior interventricular artery.

1 Introduction

We are currently perorming a study on the distribution oatherosclerosis among encephalic, cardiac and renal arteries,through the dissection o the original organs rom cadaversand microscopic evaluation.

Few articles have addressed this correlation throughoutthe world and, until now, no anatomopathological study hasevaluated the correlation o atherosclerosis in these threeorgans at the same time (BAE, YOON and KANG et al., 2006;GROSS, KRMER and WAIGAND et al., 1997; NGUYEN-HUYNH, WINTERMARK and ENGLSIH et al., 2008,PARK, JUNG and SEO et al., 2004; SEO, YONG andKOH et al., 2008; WEI, LI and ZHAO, 2007).

Beore dissecting, the AMA Study evaluates thearteries macroscopically, searching or malormations. Wecommunicate now an unexpected correlation we haveidentifed.

2 Short communication

We have already perormed 24 dissections during theyear o 2010; o these, six brains have shown malormationsaecting the posterior cerebral arteries (PCA) in the circleo Willis. Three right PCA originated rom the right internal

carotid artery (ICA); one let PCA originated rom the letICA; and in two brains, both PCA originated rom bothICAs.

Among these 24 dissections, we have also identifedseveral abnormalities within the cardiac arterial bed.In three o them, the posterior interventricular artery(PIA) originated rom the let, rather than rom the rightcoronary artery. In all three cases, we have also ound theabovementioned abnormalities in the circle o Willis: in two,both PCA originated rom the ICAs; and in one, the rightPCA originated rom the right ICA.

Below we show the picture o a heart with right ventricular hypoplasia (Figures 1 and 2) and its respectivebrain, whose basilar artery established no connection with

the circle o Willis (Figures 3 to 5), in contrast to anotherbrain, whose PCA originated rom the ICAs and establishedconnections to the basilar artery through three thin vessels(Figures 6 and 7). The respective heart is not shown.

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Figure 1. Anterior view o the heart. 1) AnteriorInterventricular artery; 2) Diagonal Arteries; 3) RightVentricle; 4) Interventricular septum; 5)Let ventricle; 6) Rightauricular; 7) Aorta and 8) Pulmonary arteries.

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Malformation of cardiac and cerebral arteries

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Figure 2. Posterior view o the heart. 1) PosteriorInterventricular artery; 2) Marginal artery; 3) Let coronaryartery; 4) Let ventricle; 5)Let atrium and 6) Right atrium.

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Figure 3. Inerior view o the encephalon. 1) Anteriorsuperior cerebellar artery; 2) Basilar artery (partiallycut); 3) Posterior inerior cerebellar arteries; 4) Posteriorcerebral arteries; 5) Posterior communicant arteries; 6) Internalcarotid (cut); 7) Medium cerebral arteries; 8) Anterior cerebralarteries and 9) Arterial malormation connecting both posteriorcerebral arteries.

Figure 4. Close up on the Circle o Willis.

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Figure 5. Dissected Circle o Willis. 1) Posterior cerebralarteries; 2) Posterior communicant arteries; 3) Medium cerebralarteries; 4) Anterior cerebral arteries; 5) Internal carotidand 6) Vascular malormation connecting both posterior cerebralarteries (no signs o previous anastomosis to the basilar artery).

3 Discussion

Deects in the arteries composing the circle o Willis are quite common; MERKKOLA, TULLA andRONAKAINEN et al., 2006, ound that 22% o theanterior communicant arteries (ACoA) and 46% o theposterior communicant arteries (PCoA) are missing in thegeneral population. So ar, in 24 autopsies, we have oundno abnormalities in the ACoA, whereas 13 PCoA in total(4: both; 1: let; 4: right) were missing. These abnormalitiesare especially important when perorming surgery in thethoracic aorta or the carotids, when brain perusion must bemaintained by only one side o the circle o Willis.

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Nordon, DG., Guimares, RR., Camargo Neto, AA. et al.

J. Morphol. Sci., 2011, vol. 28, no. 4, p. 300-302302

statistically guarantee the correlation between an abnormalorigin o the PIA and the PCA. However, it is interestingto mention that there was a correlation: or every heart whose PIA originated rom the let coronary artery, therewas a respective brain with malormations in the posteriorcirculation o the circle o Willis. We are still waiting orurther development in our work in order to clariy thisfnding.

Acknowledgements: We are grateul or Mr. Claudio Theodoroand Mr. Marcos Antonio Bego, autopsy technicians who have beenhelping us throughout our work.

References

BAE, HJ., YOON, BW., KANG, DW., KOOA, J-S., LEEB, S-H.,KIMC, K-B., LEED, J., ROH, J-K. Correlation o coronaryand cerebral atherosclerosis: dierence between extracranial andintracranial arteries. Cerebrovascular Diseases, 2006, vol. 21, p. 112-9.PMid:16340186. http://dx.doi.org/10.1159/000090209

GROSS, CM., KRMER, J., WAIGAND, J., LUFT, FC., DIETZ, R.Relation between arteriosclerosis in the coronary and renal arteries.The American Journal of Cardiology, 1997, vol. 80, p. 1478-81.http://dx.doi.org/10.1016/S0002-9149(97)00727-3

MERKKOLA, P., TULLA, H., RONKAINEN, A., SOPPI, V.,OKSALA, A., KOIVISTO, T., HIPPELINEN, M. IncompleteCircle o Willis and Right Axillary Artery Perusion. The Annalsof Thoracic Surgery, 2006, vol. 82, p. 74-80. PMid:16798193.http://dx.doi.org/10.1016/j.athoracsur.2006.02.034

NGUYEN-HUYNH, MN., WINTERMARK, M., ENGLSIH, J.,LAM, J., VITTINGHOFF, E., SMITH, WS., JOHNSTON, SC.How accurate is CT angiography in evaluating intracranialatherosclerotic disease? Stroke, 2008, vol. 29, p. 1184-8.

PARK, S., JUNG, JH. and SEO, HS. The prevalence and clinicalpredictors o atherosclerotic renal artery stenosis in patients

undergoing coronary angiography. Heart and Vessels, 2004, vol. 19,p. 275-9. PMid:15799174. http://dx.doi.org/10.1007/s00380-004-0789-1

RUMBOLDT, Z., CASTILLO, M. and SOLANDER, S.Bilateral congenital absence o the internal carotid artery.European Radiology, 2003, vol. 13, p. L130-2. PMid:16440235.http://dx.doi.org/10.1007/s00330-002-1742-2

SEO, WK., YONG, HS., KOH, SB., SUH, S., KIM, JH., YU,S-W., LEE, J-Y. Correlation o coronary artery atherosclerosis withatherosclerosis o the intracranial cerebral artery and the extracranialcarotid artery. European Neurology, 2008, vol. 59, p. 292-8.PMid:18408369. http://dx.doi.org/10.1159/000121418

WEI, JP., LI, K., ZHAO, H., HE, JF., WEN, J., ZHOU, CY., WU, XG., WANG, JR., LI, SM., ZHANG, ZY., LING, F. The

relationship between coronary atherosclerotic stenosis andcerebral atherosclerotic stenosis. Zhonghua Xin Xue Guan Bing ZaZhi, 2007, vol. 35, p. 889-92. PMid:18206032.

Received February 12, 2011Accept October 20, 2011

One case report (RUMBOLDT, CASTILLO andSOLANDER, 2003) has incidentally ound an 11-year-oldchild with bilateral carotid congenital agenesis. In this case,brain perusion depended solely on the vertebral arteries andintegrity o the circle o Willis.

Our fnding was quite unexpected and the number oarterial malormations we have ound is still too small to

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Figure 6. Inerior view o the encephalon. 1) Anterior cerebralarteries; 2) Medium cerebral arteries; 3) Posterior cerebralarteries; 4) Anterior superior cerebellar arteries; 5) Basilar arteryand 6) Internal carotid (cut).

Figure 7. Dissected Circle o Willis. 1) Anterior cerebralarteries; 2) Medium cerebral arteries; 3) Posterior cerebralarteries; 4) Anterior superior cerebellar arteries; 5) Basilar arteryand 6) Internal carotid arteries (cut).

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http://dx.doi.org/10.1159/000090209http://dx.doi.org/10.1016/S0002-9149(97)00727%3C2011%3E3http://dx.doi.org/10.1016/j.athoracsur.2006.02.034http://dx.doi.org/10.1007/s00380-004-0789-1http://dx.doi.org/10.1007/s00380-004-0789-1http://dx.doi.org/10.1007/s00330-002-1742-2http://dx.doi.org/10.1159/000121418http://dx.doi.org/10.1159/000121418http://dx.doi.org/10.1007/s00330-002-1742-2http://dx.doi.org/10.1007/s00380-004-0789-1http://dx.doi.org/10.1007/s00380-004-0789-1http://dx.doi.org/10.1016/j.athoracsur.2006.02.034http://dx.doi.org/10.1016/S0002-9149(97)00727%3C2011%3E3http://dx.doi.org/10.1159/000090209