The relative anatomy of the coronary arterial and venous systems

Abstract

An anatomical understanding of human coronary arterial and venous systems is necessary for device development and therapy applications that utilize these vessels. We investigated the unique use of contrast-CT scans from perfusion-fixed human hearts for three-dimensional visualization and analysis of anatomical features of the coronary systems. The coronary arterial and venous systems of eleven perfusion-fixed human hearts were modeled using contrast-CT and Mimics software. The coronary arteries that coursed near the major coronary veins, how close coronary arteries were to coronary veins, and the size of adjacent coronary arteries were recorded and analyzed. The majority of coronary veins were within 5 mm of a coronary artery somewhere along its length. Interventricular veins elicited the largest occurrence of overlaps. There was significant variability in the percentage of each vein that coursed within 0.5, 1, 2, and 5 mm of a nearby artery. The left marginal veins and anterior interventricular vein had the largest portion of the vein that coursed near a coronary artery. The right coronary artery most often coursed near the middle cardiac vein. The inferior veins of the left ventricle elicited the most variation in adjacent arteries. The left circumflex artery and/or branches of the circumflex artery coursed near the left marginal vein in all cases where there was an artery near the marginal vein. The wide variation of measurements reinforces the importance of a precise understanding of individualized cardiac anatomy in order to provide the highest quality care to cardiac patients.

Coronary bifurcations as you have never seen them: the Visible Heart® Laboratory bifurcation programme

“…Once a surgical plane of anaesthesia is sustained, a medial sternotomy is performed and a standard cardioplegia solution is rapidly administered (at ~150 mmHg via the aortic cannula) to depolarise the heart. Then, the isolated heart is reanimated using previously published Visible Heart ® methodologies [3][4][5][6][7] . Briefly, the great vessels of the heart are cannulated and attached to the Visible Heart ® apparatus.…”

Comparative anatomy and angiography of the cardiac coronary venous system in four species: human, ovine, porcine, and canine

“…Studies of cardiac vascularization have focused largely on the arterial system as coronary artery pathology is responsible for the majority of cardiovascular related mortality and morbidity in humans, especially in developed countries [3][4][5][6]. However, with the advent of new treatment options for various cardiovascular diseases, such as biventricular pacing, ablation procedures, and implantation of medical devices (as with percutaneous mitral annuloplasty), the coronary sinus (CS) is increasingly used to access the coronary venous system [5,[7][8][9][10][11][12][13]. Knowledge of coronary venous anatomy has therefore become important, and pre-clinical research focusing on the CS has increased dramatically [5,[14][15][16][17][18][19][20][21][22].…”

Multimodal Comparisons of Results Achieved by Different Side Branch Ballooning Techniques for Bifurcation Provisional Stenting

“…After these steps, each heart was explanted, and all great vessels were cannulated and connected to an ex vivo Visible Heart apparatus. 19,20 Subsequently, each heart was warmed and perfused with a Krebs-Henseleit buffer 19 and then defibrillated with a ~30 J shock to induce a sinus rhythm. Next, bifurcation PCIs were performed on these reanimated hearts under multimodality imaging guidance with standard fluoroscopy (OEC Elite Fluoroscopy, GE Healthcare, Chicago, IL) in parallel with intracoronary angioscopy, using 2.4- and 4-mm fiberscopes (Olympus Corporation, Japan) placed immediately proximal to the bifurcation to allow intracoronary direct visualization of each procedural step.…”

“…After these steps, each heart was explanted, and all great vessels were cannulated and connected to an ex vivo Visible Heart apparatus. 19,20 Subsequently, each heart was warmed and perfused with a Krebs-Henseleit buffer 19 and then defibrillated with a ~30 J shock to…”