Anatomical Study of the Triangle of Brocq and Mouchet and Its Clinical Implications for Coronary Interventions in Human Cadaveric Hearts.

内容摘要

The triangle of Brocq and Mouchet is a clinically significant arteriovenous region on the anterior surface of the heart, formed by the anterior interventricular artery (AIV), circumflex artery (Cx), and great cardiac vein (GCV). Despite its relevance in cardiac surgery and interventional cardiology, detailed anatomical characterization of this region remains limited. This study aimed to evaluate the presence, morphological variations, and vascular relationships of the triangle of Brocq and Mouchet in human cadaveric hearts, with emphasis on its clinical significance.  A descriptive cadaveric study was conducted on 30 adult human hearts obtained from routine anatomical dissections at Sri Ramachandra Institute of Higher Education and Research (Deemed to be University) (SRIHER (DU)). Specimens with intact coronary vasculature were included. Detailed microdissection was performed to identify the LAD, Cx, and GCV. The arteriovenous triangle was first assessed for its presence and morphology. Based on the anatomical configuration formed by the AIV, Cx, and GCV, the triangle was classified into five morphological types: closed, inferiorly open, superiorly open, completely open, and absent. The relationship of the GCV with the LAD and Cx was recorded as superficial, deep, crossing, or parallel. Additional arterial components, including median and diagonal branches, were documented.  The triangle was present in 28 (93.3 %) specimens. The closed type was the most frequent pattern (15 (50%) specimens), followed by the inferiorly open type (12 (40%) specimens), the superiorly open type (1 (3.3%) specimen), and absence of the triangle (2 (6.7%) specimens). No completely open type was observed. The GCV was predominantly deep to the LAD (16 (59.3%) specimens) and superficial to the Cx (21 (72.4%) specimens), with mixed relationships observed in 15 (50%) specimens. Additional arterial components were identified as the median artery in 11 (39.3%) specimens and diagonal branches in 8 (28.6%) specimens, with most structures located superficial to the GCV in 17 (60.7%) specimens. The triangle of Brocq and Mouchet showed high prevalence and considerable anatomical variability in morphology and vascular relationships. These variations have important implications for coronary interventions, including catheterization, coronary artery bypass grafting (CABG), and electrophysiological procedures. A comprehensive anatomical understanding of this region is essential for improving procedural safety, minimizing iatrogenic complications, and supporting better clinical outcomes.