A detailed assessment of the human coronary venous system using contrast computed tomography of perfusion-fixed specimens
A detailed assessment of the human coronary venous system using contrast computed tomography of perfusion-fixed specimens
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DOI：
10.1016/j.hrthm.2013.10.038
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发表时间：
2014-02-01
期刊：
影响因子：
5.5
通讯作者：
Iaizzo, Paul A.
中科院分区：
文献类型：
--
作者：
Spencer, Julianne H.;Larson, AllisonA.;Iaizzo, Paul A.
背景技术需要进入冠状静脉系统来递送多种心脏治疗，包括心脏再同步治疗、冠状窦消融和冠状动脉药物递送。因此，冠状静脉解剖结构的表征将为改善进入这些血管以及随后改进治疗提供见解。例如，心脏再同步治疗的无反应率为 30%，部分原因是冠状静脉内的导线放置不理想。 目的 了解冠状静脉解剖结构对于开发在这些血管内部署的装置的影响。方法 我们用静脉造影球囊导管对 121 颗灌注固定的人类心脏的冠状窦进行插管，并将造影剂注射到静脉系统中，同时获得计算机断层扫描图像。对于每条主要冠状静脉，根据重建的解剖结构评估到冠状窦的距离、分支角度、弧长、迂曲度、分支数量和开口直径。 结果 29% (35/121) 的样本没有覆盖心脏下外侧的静脉分支，其大小足以容纳 5F 起搏导线。在具有不同心脏病史的亚组之间没有发现显着的解剖学差异。结论本研究中采用的解剖学方法允许开发人类冠状静脉解剖学的独特数据库，该数据库可用于优化心脏装置的设计和交付。
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 data base of human coronary venous anatomy that can be used for the optimization of design and delivery of cardiac devices.