Three‐dimensional Visualization of Spatial Relationships Between Coronary Veins and Arteries.

Abstract

Knowledge of the mutual relationship between the main arteries and veins of the heart is crucial for the safety and effectiveness of interventional and electrophysiological procedures. Thus, the aim of this study was to assess the spatial relationships of main coronary blood vessels using virtual three‐dimensional visualizations. Seventy patients that underwent contrast‐enhanced electrocardiogram‐gated multi‐slice computed tomography of the heart were investigated. Coronary vasculature was segmented and visualized in three dimensions using semi‐automatic algorithms (Mimics Innovation Suite 22.0, Materialise). Right coronary artery dominance was identified in 81.4%, whereas left artery dominance in 11.4% and codominance in 7.1%. The coronary sinus, great cardiac vein and the middle cardiac vein were observed in all patients. Within the inferior interventricular sulcus, the artery was mainly located on the right side of the middle cardiac vein (87.1%), in 58.6% of cases these vessels crossed each other, mostly in their distal part. The coronary sinus was accompanied by the left circumflex artery in 88.6%, but their mutual course was highly variable. In 42.3% the circumflex artery crossed coronary sinus once, in 32.9% twice and in 2.9% three times. The left anterior descending artery was located on the right side of the great cardiac vein in 90.0%, in 51.1% these vessels crossed each other, mainly in middle sector of anterior interventricular sulcus. In conclusion, main coronary arteries and veins cross each other on many levels. Three‐dimensional pre‐procedural coronary vessels visualization is useful tool that may help to plan the procedure and increase its safety and efficiency.