Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens

Abstract

A detailed understanding of the complexity and relative variability within the human cardiac venous system is crucial for the development of cardiac devices that require access to these vessels. For example, cardiac venous anatomy is known to be one of the key limitations for the proper delivery of cardiac resynchronization therapy (CRT) 1 Therefore, the development of a database of anatomical parameters for human cardiac venous systems can aid in the design of CRT delivery devices to overcome such a limitation. In this research project, the anatomical parameters were obtained from 3D reconstructions of the venous system using contrast-computed tomography (CT) imaging and modeling software (Materialise, Leuven, Belgium). The following parameters were assessed for each vein: arc length, tortuousity, branching angle, distance to the coronary sinus ostium, and vessel diameter.CRT is a potential treatment for patients with electromechanical dyssynchrony. Approximately 10-20% of heart failure patients may benefit from CRT 2 . Electromechanical dyssynchrony implies that parts of the myocardium activate and contract earlier or later than the normal conduction pathway of the heart. In CRT, dyssynchronous areas of the myocardium are treated with electrical stimulation. CRT pacing typically involves pacing leads that stimulate the right atrium (RA), right ventricle (RV), and left ventricle (LV) to produce more resynchronized rhythms. The LV lead is typically implanted within a cardiac vein, with the aim to overlay it within the site of latest myocardial activation.We believe that the models obtained and the analyses thereof will promote the anatomical education for patients, students, clinicians, and medical device designers. The methodologies employed here can also be utilized to study other anatomical features of our human heart specimens, such as the coronary arteries. To further encourage the educational value of this research, we have shared the venous models on our free access website: www.vhlab.umn.edu/atlas. Video LinkThe video component of this article can be found at

The Prevalence of Coronary Sinus and Left Circumflex Artery Overlap in Relation to the Mitral Valve

“…The hearts were obtained from organ donors whose hearts were deemed not viable for transplant and recovered through a collaboration with LifeSource, Inc. (St. Paul, MN, USA). Each freshly obtained human heart was perfusion‐fixed by cannulating the great vessels and attaching them to an upper delivery chamber of formalin while immersed in a lower chamber of formalin . Formalin was pumped to the upper chamber to maintain a physiological head pressure for a minimum of 24 hours.…”

“…Each freshly obtained human heart was perfusion-fixed by cannulating the great vessels and attaching them to an upper delivery chamber of formalin while immersed in a lower chamber of formalin. 7,8 Formalin was pumped to the upper chamber to maintain a physiological head pressure for a minimum of 24 hours. This method fixed the specimens in an approximation of their enddiastolic state.…”

“…1 14.3 ± 3.1 14.0 ± 3.3 11.4 ± 3.2 11.0 ± 4.7 p = 0.03* p = 0.03* p = 0.07 p = 0.08 p = 0.05 9.4 ± 3.3 13.8 ± 3.6 13.3 ± 3.5 10.9 ± 2.7 10.7 ± 4.0 p = 0.13 p = 0.07 p = 0.21 p = 0.13 p = 0.03* Healthy NA 7.5 ± 2.5 10.7 ± 5.3 9.5 ± 3.4 8.3 ± 3.8 9.5 ± 3.9 12.4 ± 3. 8 11.6 ± 4.3 11.5 ± 4.5 9.0 ± 3.8 10.5 ± 3.4 p = 0.05 p = 0.62 p = 0.16 p = 0.41 p = 0.68 7.8 ± 2. 4 12.6 ± 5.3 10.3 ± 4.6 10.0 ± 4.7 10.3 ± 4.6 12.9 ± 0.4 p = NA p = 0.17 p = 0.94 p = 0.81 p = 0.13 p = 0.23 10.8 ± 3.…”

Left phrenic nerve anatomy relative to the coronary venous system: Implications for phrenic nerve stimulation during cardiac resynchronization therapy

“…Contrast was injected into the coronary venous system at 5 mL sec 21 through a venogram balloon catheter placed in the coronary sinus as previously described (Spencer et al, 2013b). A small wire was glued to the left phrenic nerve of each specimen so that it could be detected on the CT scans.…”

“…Each heart-lung bloc was placed in the scanner in its supine anatomical position. Contrast was injected into the coronary venous system at 5 mL sec 21 through a venogram balloon catheter placed in the coronary sinus as previously described (Spencer et al, 2013b). The CT scan was obtained using a Siemens 64 multi-detector scanner (Munich, Germany).…”