Advertisement

Surgical and Radiologic Anatomy

, Volume 31, Issue 8, pp 597–604 | Cite as

Ex vivo and in vivo coronary ostial locations in humans

  • Joseph Knight
  • Vartan Kurtcuoglu
  • Karl Muffly
  • William MarshallJr
  • Paul Stolzmann
  • Lotus Desbiolles
  • Burkhardt Seifert
  • Dimos Poulikakos
  • Hatem Alkadhi
Original Article

Abstract

Purpose

Knowledge of the normal in vivo distribution and variation of coronary ostial locations is essential in the planning of various interventional and surgical procedures. However, all studies to date have reported the distribution of coronary ostia locations only in cadaver hearts. In this study, we sought to assess the distribution of coronary ostial locations in patients using cardiac dual-source computed tomography (CT) and compare these values to those of human cadaveric specimens.

Methods

Measurements of the coronary ostia location were performed in 150 patients undergoing dual-source CT and in 75 cadavers using open measurement techniques. All 150 patients had a normal aortic valve function and no previous cardiac intervention or surgery. The location of the right and left coronary origin in relation to the aortic annulus and the height of the sinus of Valsalva were measured.

Results

Mean ostial locations at CT were 17.0 (±3.6) mm and 15.3 (±3.1) mm for the right and left coronary ostia, with large variations of both sides (right: 10.4–28.5 mm; left: 9.8–29.3 mm). In cadavers, mean locations were 14.9 (±4.3) mm [5–24 mm] for right and 16.0 (±3.6) mm [9–24 mm] for left coronary ostia. Comparison of CT and cadaver data showed statistically significant differences for right (P < 0.0001) but not left (P = 0.1675) coronary ostia.

Conclusions

This study provides data of normal coronary ostial origins and demonstrates significant differences between in vivo and ex vivo measurements regarding the right coronary ostium. The observed large variations of coronary ostia origins emphasize the importance of considering such anatomic variations in the development of treatments.

Keywords

Coronary ostia Coronary artery Heart Anatomy Computed tomography 

Notes

Acknowledgments

This paper was supported by the National Center of Competence in Research for Computer Aided and Image Guided Medical Interventions (NCCR CO-ME) of the Swiss National Science Foundation.

References

  1. 1.
    Alkadhi H, Scheffel H, Desbiolles L, Gaemperli O, Stolzmann P, Plass A, Goerres GW, Luescher TF, Genoni M, Marincek B, Kaufmann PA, Leschka S (2008) Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy. Eur Heart J 29(6):766–776PubMedCrossRefGoogle Scholar
  2. 2.
    Babaliaros V, Block P (2007) State of the art percutaneous intervention for the treatment of valvular heart disease: a review of the current technologies and ongoing research in the field of percutaneous valve replacement and repair. Cardiology 107(2):87–96PubMedCrossRefGoogle Scholar
  3. 3.
    Berdajs D, Lajos P, Turina M (2002) The anatomy of the aortic root. Cardiovasc Surg 10(4):320–327PubMedCrossRefGoogle Scholar
  4. 4.
    Boudjemline Y, Bonhoeffer P (2002) Steps toward percutaneous aortic valve replacement. Circulation 105(6):775–778PubMedCrossRefGoogle Scholar
  5. 5.
    Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, Guerci AD, Lima JA, Rader DJ, Rubin GD, Shaw LJ, Wiegers SE (2006) Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114(16):1761–1791PubMedCrossRefGoogle Scholar
  6. 6.
    Cavalcanti JS, de Melo NC, de Vasconcelos RS (2003) Morphometric and topographic study of coronary ostia. Arq Bras Cardiol 81(4):359–362, 355-358PubMedCrossRefGoogle Scholar
  7. 7.
    Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300(24):1350–1358PubMedCrossRefGoogle Scholar
  8. 8.
    Du Bois D, Du Bois EF (1989) A formula to estimate the approximate surface area if height, weight be known 1916. Nutrition 5(5):303–311 (discussion 312–313)PubMedGoogle Scholar
  9. 9.
    Flecher EM, Curry JW, Joudinaud TM, Kegel CL, Weber PA, Duran CM (2007) Coronary flow obstruction in percutaneous aortic valve replacement an in vitro study. Eur J Cardiothorac Surg 32(2):291–294PubMedCrossRefGoogle Scholar
  10. 10.
    Hendel RC, Bateman TM, Cerqueira MD, Iskandrian AE, Leppo JA, Blackburn B, Mahmarian JJ (2005) Initial clinical experience with regadenoson, a novel selective A2A agonist for pharmacologic stress single-photon emission computed tomography myocardial perfusion imaging. J Am Coll Cardiol 46(11):2069–2075PubMedCrossRefGoogle Scholar
  11. 11.
    Huber CH, Tozzi P, Corno AF, Marty B, Ruchat P, Gersbach P, Nasratulla M, von Segesser LK (2004) Do valved stents compromise coronary flow? Eur J Cardiothorac Surg 25(5):754–759PubMedCrossRefGoogle Scholar
  12. 12.
    Jatene MB, Monteiro R, Guimaraes MH, Veronezi SC, Koike MK, Jatene FB, Jatene AD (1999) Aortic valve assessment. Anatomical study of 100 healthy human hearts. Arq Bras Cardiol 73(1):75–86PubMedCrossRefGoogle Scholar
  13. 13.
    Leschka S, Scheffel H, Desbiolles L, Plass A, Gaemperli O, Valenta I, Husmann L, Flohr TG, Genoni M, Marincek B, Kaufmann PA, Alkadhi H (2007) Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG-pulsing windowing. Invest Radiol 42(8):543–549PubMedCrossRefGoogle Scholar
  14. 14.
    Lutter G, Ardehali R, Cremer J, Bonhoeffer P (2004) Percutaneous valve replacement: current state and future prospects. Ann Thorac Surg 78(6):2199–2206PubMedCrossRefGoogle Scholar
  15. 15.
    Muriago M, Sheppard MN, Ho SY, Anderson RH (1997) Location of the coronary arterial orifices in the normal heart. Clin Anat 10(5):297–302PubMedCrossRefGoogle Scholar
  16. 16.
    Scheffel H, Alkadhi H, Plass A, Vachenauer R, Desbiolles L, Gaemperli O, Schepis T, Frauenfelder T, Schertler T, Husmann L, Grunenfelder J, Genoni M, Kaufmann PA, Marincek B, Leschka S (2006) Accuracy of dual-source CT coronary angiography: First experience in a high pre-test probability population without heart rate control. Eur Radiol 16(12):2739–2747PubMedCrossRefGoogle Scholar
  17. 17.
    Stolzmann P, Scheffel H, Schertler T, Frauenfelder T, Leschka S, Husmann L, Flohr TG, Marincek B, Kaufmann PA, Alkadhi H (2007) Radiation dose estimates in dual-source computed tomography coronary angiography. Eur Radiol 18:592–599PubMedCrossRefGoogle Scholar
  18. 18.
    Stolzmann P, Scheffel H, Schertler T, Frauenfelder T, Leschka S, Husmann L, Flohr TG, Marincek B, Kaufmann PA, Alkadhi H (2008) Radiation dose estimates in dual-source computed tomography coronary angiography. Eur Radiol 18(3):592–599PubMedCrossRefGoogle Scholar
  19. 19.
    Swanson M, Clark RE (1974) Dimensions and geometric relationships of the human aortic valve as a function of pressure. Circ Res 35(6):871–882PubMedGoogle Scholar
  20. 20.
    Thubrikar M (1990) The aoric valve. CRC Press, Inc, Boca Raton, Florida, USAGoogle Scholar
  21. 21.
    Turner K, Navaratnam V (1996) The positions of coronary arterial ostia. Clin Anat 9(6):376–380PubMedCrossRefGoogle Scholar
  22. 22.
    Vlodver Z, Vlodaver Neufeld HN, Edward JE (1975) Coronary arterial variations in the normal heart and in congential heart disease. Academic Press Inc, New YorkGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Joseph Knight
    • 1
  • Vartan Kurtcuoglu
    • 1
  • Karl Muffly
    • 2
  • William MarshallJr
    • 2
  • Paul Stolzmann
    • 3
  • Lotus Desbiolles
    • 3
  • Burkhardt Seifert
    • 4
  • Dimos Poulikakos
    • 1
  • Hatem Alkadhi
    • 3
  1. 1.Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process EngineeringETH ZurichZurichSwitzerland
  2. 2.College of MedicineUniversity of South FloridaTampaUSA
  3. 3.Biostatistics Unit, ISPMUniversity of ZurichZurichSwitzerland
  4. 4.Institute of Diagnostic RadiologyUniversity Hospital ZurichZurichSwitzerland

Personalised recommendations