Anatomy and function relation in the coronary tree: from bifurcations to myocardial flow and mass

Area of Science:

• Cardiovascular Science
• Biomedical Engineering
• Medical Imaging

Background:

• Coronary bifurcations are complex structures crucial for myocardial perfusion.
• Understanding their geometry-function relationship is vital for effective treatment strategies.
• Current assessment methods may not fully capture the functional significance of side branches.

Purpose of the Study:

• To establish quantitative relationships between coronary bifurcation geometry, blood flow distribution, and perfused myocardial mass.
• To develop practical rules for optimizing the treatment of bifurcations, including side branches (SB).
• To extend these rules to trifurcations for comprehensive branching pattern therapy.

Main Methods:

• Utilizing scaling laws for flow-diameter and myocardial mass-diameter relationships.
• Applying principles of mass conservation.
• Deriving geometric relations between segment diameters, SB flow fraction, and perfused myocardial mass.

Main Results:

• Demonstrated that SB functional significance depends on SB diameter, mother vessel diameter, and proximal main artery diameter.
• Quantified the influence of these geometric factors on flow fraction distribution and perfused myocardial mass.
• Extended bifurcation rules to trifurcations, providing scalable therapy guidelines.

Conclusions:

• Optimal treatment of coronary bifurcations requires considering multiple geometric parameters, not just SB diameter.
• The derived quantitative rules offer a framework for improved interventional strategies.
• This approach ensures functional restoration by considering the entire branching architecture.