Ex vivo analysis of human coronary bifurcation anatomy: defining the main vessel-to-side-branch transition zone.
OBJECTIVE
Defining vessel diameters and angles that comprise coronary side-branch intersections could assist in tailoring treatments to match anatomy, improve haemodynamic flow, and minimise mechanical trauma. We sought to characterise intersections of main vessels and side-branches by measuring actual diameters, angles, and shapes at the ostia in human coronary arteries.


RESULTS
Polymer casts were created using coronary trees from 23 adult cadaver hearts. Seventy-five arterial intersections between main vessels and side-branches were captured using the combination of a microscope (Smartscope MVP100) and computer program (Gage-X metrology software) specifically calibrated for video-based inspection and measurement (34-fold magnification). The intersection between main vessels and side-branches was a multifaceted, curvilinear transition rather than a bisecting angle. The shape of the ostia was typically elliptical rather than circular. Mean diameters were 2.88 mm in proximal main vessels, 2.34 mm in ostia, and 2.00 mm in side-branches (first-level branches). Obtuse proximal (150 degrees) and distal (111 degrees) angles with accentuated side-branch taper create a "barn door" effect with wider curvature at the bottom.


CONCLUSIONS
Matching treatments to these various forms of asymmetry at the main vessel-to-side-branch intersection may minimise injury and optimise scaffolding, and haemodynamic flow.
Russell
Mary E
ME
Ascent Translational Sciences, Carlisle, MA, USA. maryrussell343@comcast.net
Binyamin
Gary
G
Konstantino
Eitan
E
D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002102:Cadaver; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000033:anatomy & histology*; D016319:Corrosion Casting; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D013552:Swine