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Anatomy of the first septal perforating artery: a study with implications for ablation therapy for hypertrophic
M Singh1, W D Edwards, D R Holmes
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Insights
The first septal perforating artery (FSPA) shows significant size and distribution variability. This variation impacts septal supply and may necessitate pre-procedural evaluation in hypertrophic cardiomyopathy (HCM) patients.
Area of Science:
- Cardiovascular Anatomy
- Interventional Cardiology
Background:
- The first septal perforating artery (FSPA) is crucial for basal septal perfusion.
- Understanding FSPA variability is important for cardiac interventions like alcohol septal ablation.
Purpose of the Study:
- To investigate the anatomical variability in the size and distribution of the FSPA.
- To assess FSPA characteristics in both healthy hearts and those with hypertrophic cardiomyopathy (HCM).
Main Methods:
- Autopsy examination of 10 non-HCM hearts to evaluate FSPA size and distribution.
- Coronary angiography in 8 HCM patients undergoing alcohol septal ablation to measure FSPA size.
Main Results:
- Autopsy hearts revealed diverse FSPA sizes (tiny to large) and distribution patterns, with some supplying non-septal areas or leaving the basal septum incompletely perfused.
- In HCM patients, FSPA diameters varied significantly, with some exceeding 2 mm.
Conclusions:
- Substantial variability exists in FSPA size and distribution, affecting myocardial perfusion.
- The FSPA's territory can extend beyond the basal septum or fail to fully supply it.
- Pre-procedural assessment of FSPA anatomy is recommended for HCM patients undergoing alcohol septal ablation.
Objective:
To determine the variability in the size and distribution of the first septal perforating artery (FSPA).
Material And Methods:
In this pilot study, 10 fresh autopsy hearts from patients who did not have hypertrophic cardiomyopathy (HCM) or clinical evidence of coronary artery disease were evaluated for the variability in the size of the FSPA. The size of the FSPA was also measured during coronary angiography in 8 patients with HCM who were undergoing alcohol septal ablation.
Results:
Of the 10 autopsy hearts, 2 had a large FSPA (> or = 1.0 mm in maximal diameter) with prominent septal myocardial distribution, 2 had a medium-sized FSPA (0.5-0.9 mm), 2 had a small FSPA (0.1-0.4 mm), 3 had a tiny FSPA (< 0.1 mm), and 1 had an indiscernible ostium. In 2 patients the FSPA supplied the right ventricular free wall. In 4 patients the basal ventricular septum was incompletely supplied by the FSPA. Of the 8 patients with HCM, the FSPA was larger than 2 mm in diameter in 2 patients, 1 to 2 mm in 4, and smaller than 1 mm in 2. The distance between the left anterior descending coronary artery ostium and the origin of the FSPA ranged between 13.1 and 37.4 mm, indicating a large variation in the size and distribution of the FSPA.
Conclusions:
Variability in the size and distribution of the FSPA in patients without HCM was substantial. Areas of the heart other than the basal septum were supplied in some patients by the FSPA. In other patients the FSPA did not supply the entire basal septum. Similar findings were noted in patients with HCM. A detailed evaluation of the distribution of the FSPA may be necessary in all patients with HCM who are undergoing alcohol septal ablation.
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