Noncoronary Collateral Myocardial Blood Flow: The Human Heart’s Forgotten Blood Supply

摘要

The “noncoronary collateral circulation” (NCCC) or “noncoronary collateral myocardial blood flow”(NCCMBF), reaches the heart through a micro-vascular network arising from the bronchial, esophageal, pericardial,diaphragmatic, and aortic arteries. The left and right internal thoracic arteries (ITAs) along with their collateral branchesalso serve as a source of NCCMBF-a feature seen in other mammals. Under certain circumstances the ITAs have a highpotential for developing collateral branches. In the case of severe Leriche syndrome or with chronic obstruction of theabdominal aorta, the ITAs can serve as the main or even sole source of blood supply to the lower limbs. It is also possiblefor the ITAs to develop angiographically visible branches that directly connect with the coronary arteries. In ischemicconditions there is a functional, ischemia-reducing extracardiac coronary artery supply via natural ipsilateral ITAanastomosis. To date we know little about NCCMBF and its potential benefits in clinical applications, which makes this achallenging and intriguing field of research. This paper reviews all available data on noncoronary collateral blood supplyto the human heart.