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Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
A detailed assessment of the human coronary venous system using contrast computed tomography of perfusion-fixed
Julianne H Spencer1, Allison A Larson1, Rachel Drake1
1University of Minnesota, Minneapolis, Minnesota.
Insights
Understanding coronary venous anatomy is crucial for effective cardiac device delivery. A significant percentage of hearts lack suitable venous branches for pacing leads, impacting cardiac resynchronization therapy outcomes.
Area of Science:
- Cardiovascular anatomy
- Medical device engineering
Background:
- Coronary venous access is essential for cardiac therapies like resynchronization and drug delivery.
- Suboptimal lead placement in coronary veins contributes to a 30% non-response rate in cardiac resynchronization therapy.
- Detailed characterization of coronary venous anatomy can improve device access and therapeutic efficacy.
Purpose of the Study:
- To investigate coronary venous anatomy and its implications for cardiac device development.
- To provide anatomical insights for optimizing the design and delivery of devices deployed in coronary veins.
Main Methods:
- Computed tomographic imaging of the coronary sinus in 121 human hearts after contrast injection.
- Assessment of anatomical parameters including distance, branching angle, arc length, tortuosity, branch number, and ostial diameter for major coronary veins.
- Analysis of venous branch suitability for a 5F pacing lead on the inferolateral aspect of the heart.
Main Results:
- Twenty-nine percent of hearts (35/121) lacked a sufficiently large venous branch for a 5F pacing lead in the inferolateral region.
- No significant anatomical variations were observed across different cardiac medical history subgroups.
- The study generated a comprehensive database of human coronary venous anatomy.
Conclusions:
- The employed anatomical approach yielded a unique dataset for optimizing cardiac device design and delivery.
- Findings highlight potential challenges in achieving optimal lead placement for certain cardiac therapies.
- The generated anatomical database can inform future development of cardiovascular devices.
Background:
Access to the coronary venous system is required for the delivery of several cardiac therapies including cardiac resynchronization therapy, coronary sinus ablation, and coronary drug delivery. Therefore, characterization of the coronary venous anatomy will provide insights to gain improved access to these vessels and subsequently improved therapies. For example, cardiac resynchronization therapy has a 30% nonresponder rate, partially due to suboptimal lead placement within the coronary veins.
Objective:
To understand the implications of coronary venous anatomy for the development of devices deployed within these vessels.
Methods:
We cannulated the coronary sinus of 121 perfusion-fixed human hearts with a venogram balloon catheter and injected contrast into the venous system while obtaining computed tomographic images. For each major coronary vein, distance to the coronary sinus, branching angle, arc length, tortuosity, number of branches, and ostial diameter were assessed from the reconstructed anatomy.
Results:
Twenty-nine percent (35/121) specimens did not have a venous branch overlying the inferolateral side of the heart large enough to fit a 5F pacing lead. No significant differences in anatomy were found between subgroups with varying cardiac medical histories.
Conclusion:
The anatomical approach employed in this study has allowed for the development of a unique database of human coronary venous anatomy that can be used for the optimization of design and delivery of cardiac devices.
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