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Assessment of the Human Coronary Collateral Circulation

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Collateral Circulation of the Heart

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The reference method for coronary blood flow measurements in the experimental animal model is the microsphere indicator deposition method. The principle of deposition methods is that the microsphere deposition is proportional to the flow per unit mass of tissue. Using microsphere methods and small myocardial pieces, regional flow values vary considerably between one-third and twice the average flow. This fractal vascular tree geometry is present throughout the plant and animal world, and its conservation across species is thought to be due to evolutionary advantages conferred through efficient distribution of nutrients. In that context, the coronary artery tree is structured according to the law of minimum viscous energy loss during the transport of blood, a design which principally accounts also for the option of intercoronary anastomoses. The collateral circulation is a major determinant of myocardial infarct size (IS) reduction in case of a coronary occlusion.

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Abbreviations

AR:

area at risk for myocardial infarction

C:

vascular conductance (ml/min/mmHg)

C coll :

collateral conductance

C myo :

myocardial conductance

C s :

stenosis conductance

CAD:

coronary artery disease

CPI:

collateral perfusion index

IS:

infarct size

L:

regional coronary artery branchlength (cm)

LAD:

left anterior descending coronary artery

LCA:

left coronary artery

LCX:

left circumflex coronary artery

L tot :

total summed coronary artery branchlength (cm)

LV:

left ventricle

M:

regional myocardial mass (g)

MCE:

myocardial contrast echocardiography

MR:

magnetic resonance imaging

M tot :

total myocardial mass (g)

Q:

coronary blood flow rate (ml/min)

P ao :

aortic pressure (mmHg)

P d :

distal coronary pressure (mmHg)

PET:

positron emission tomography

P occl :

distal coronary occlusive or wedge pressure (mmHg)

PCI:

percutaneous coronary intervention

R:

vascular resistance (mmHg/ml/min)

R m :

microvascular resistance (mmHg/ml/min)

RCA:

right coronary artery

SPECT:

single photon emission computer tomography

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  1. Klinik und Poliklinik for Kardiologie, Universitätsklinikum Bern Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland

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Seiler, C. (2009). Assessment of the Human Coronary Collateral Circulation. In: Collateral Circulation of the Heart. Springer, London. https://doi.org/10.1007/978-1-84882-342-6_2

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