Right coronary artery

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A Moment in History

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles, also known as "Halsted's Rules of Surgery", set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
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Details: Published: October 16, 2013

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The right coronary artery (RCA) is one of the two branches that arises from the ascending aorta and provide blood supply to the heart. The RCA begins at the coronary ostium, situated usually within the right sinus of Valsalva found in the aortic valve, one of the semilunar valves of the heart.

The RCA gives off in its initial course two arteries: the conus artery, which gives blood to the conus arteriosus, the outflow tract of the right ventricle, and the artery to the sinoatrial (SA) node, a component of the conduction system of the heart.

The RCA descends in the atrioventricular sulcus, giving off a series of small right ventricular branches and a couple of small right atrial branches, it then bends around the acute margin (margo acutus) and passes to the posterior surface of the heart. Just before the RCA bends posteriorly, it will give off the acute marginal artery, usually a thin, longer branch that extends towards the cardiac apex.

In its posterior trajectory the RCA gives off a couple of small posterior right ventricular arteries and then ends at the crux cordis, where the RCA gives off the posterior interventricular artery, commonly known as the posterior descending artery (PDA). The RCA will also give off the posterolateral artery, which, situated in the atrioventricular sulcus, extends the vascular territory of the RCA into the region of the left ventricle. This origin of the PDA from the RCA is subject to anatomical variation, which gives origin to the concept of coronary dominance.

Arising from the terminal portion of the RCA (sometimes from the posterolateral artery) is the artery to the atrioventricular (AV) node, another component of the conduction system of the heart. It is easily understood that stricture or stenosis of the RCA (depending on location) can then lead to damage of the conduction system of the heart.

Human heart and coronary artery anatomy and pathology are some of the many lecture topics developed and presented by Clinical Anatomy Associates, Inc.

Image property of: CAA.Inc.Artist: Victoria G. Ratcliffe

Right coronary artery

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