Abstract
BackgroundMany processes contributing to the functional and structural regulation of the coronary circulation have been identified. A proper understanding of the complex interplay of these processes requires a quantitative systems approach that includes the complexity of the coronary network. The purpose of this study was to provide a detailed quantification of the branching characteristics and local hemodynamics of the human coronary circulation.MethodsThe coronary arteries of a human heart were filled post-mortem with fluorescent replica material. The frozen heart was alternately cut and block-face imaged using a high-resolution imaging cryomicrotome. From the resulting 3D reconstruction of the left coronary circulation, topological (node and loop characteristics), topographic (diameters and length of segments), and geometric (position) properties were analyzed, along with predictions of local hemodynamics (pressure and flow).ResultsThe reconstructed left coronary tree consisted of 202,184 segments with diameters ranging from 30 μm to 4 mm. Most segments were between 100 μm and 1 mm long. The median segment length was similar for diameters ranging between 75 and 200 μm. 91% of the nodes were bifurcations. These bifurcations were more symmetric and less variable in smaller vessels. Most of the pressure drop occurred in vessels between 200 μm and 1 mm in diameter. Downstream conductance variability affected neither local pressure nor median local flow and added limited extra variation of local flow. The left coronary circulation perfused 358 cm3 of myocardium. Median perfused volume at a truncation level of 100 to 200 μm was 20 mm3 with a median perfusion of 5.6 ml/min/g and a high local heterogeneity.ConclusionThis study provides the branching characteristics and hemodynamic analysis of the left coronary arterial circulation of a human heart. The resulting model can be deployed for further hemodynamic studies at the whole organ and local level.
Highlights
MATERIALS AND METHODSThe coronary arterial circulation consists of a myriad of vessel segments, starting at the main stem and right coronary artery and repeatedly branching toward the smallest arterioles that connect to the capillary bed
This system is challenged in coronary artery disease (CAD), where proximal stenoses cause flow impairment
To the best of our knowledge, no extensive studies have been made on branching patterns and related hemodynamics in the human coronary circulation
Summary
The coronary arterial circulation consists of a myriad of vessel segments, starting at the main stem and right coronary artery and repeatedly branching toward the smallest arterioles that connect to the capillary bed. This system, covering around a 500-fold range in diameters in humans, normally allows for adequate matching of local perfusion to the oxygen needs. It is generally believed that the coronary artery structure adapts to allow for optimal perfusion capacity, the concepts and mechanisms here are far less clear (Seiler et al, 1992; Kassab, 2005) This system is challenged in coronary artery disease (CAD), where proximal stenoses cause flow impairment. The purpose of this study was to provide a detailed quantification of the branching characteristics and local hemodynamics of the human coronary circulation
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