Kassab Ghassan S, Finet Gerard
California Medical Innovations Institute, San Diego, CA, USA.
EuroIntervention. 2015;11 Suppl V:V13-7. doi: 10.4244/EIJV11SVA3.
The study of the structure-function relation of coronary bifurcations is necessary not only to understand the design of the vasculature but also to use this understanding to restore structure and hence function. The objective of this review is to provide quantitative relations between bifurcation anatomy or geometry, flow distribution in the bifurcation and degree of perfused myocardial mass in order to establish practical rules to guide optimal treatment of bifurcations including side branches (SB). We use the scaling law between flow and diameter, conservation of mass and the scaling law between myocardial mass and diameter to provide geometric relations between the segment diameters of a bifurcation, flow fraction distribution in the SB, and the percentage of myocardial mass perfused by the SB. We demonstrate that the assessment of the functional significance of an SB for intervention should not only be based on the diameter of the SB but also on the diameter of the mother vessel as well as the diameter of the proximal main artery, as these dictate the flow fraction distribution and perfused myocardial mass, respectively. The geometric and flow rules for a bifurcation are extended to a trifurcation to ensure optimal therapy scaling rules for any branching pattern.
研究冠状动脉分叉的结构-功能关系不仅对于理解脉管系统的设计是必要的，而且对于利用这种理解来恢复结构并进而恢复功能也是必要的。本综述的目的是提供分叉解剖结构或几何形状、分叉处血流分布与灌注心肌质量程度之间的定量关系，以便建立实用规则来指导包括侧支（SB）在内的分叉的最佳治疗。我们利用血流与直径之间的缩放定律、质量守恒以及心肌质量与直径之间的缩放定律，来提供分叉各段直径、侧支血流分数分布以及侧支灌注心肌质量百分比之间的几何关系。我们证明，对侧支进行干预的功能意义评估不仅应基于侧支的直径，还应基于母血管的直径以及近端主动脉的直径，因为它们分别决定了血流分数分布和灌注心肌质量。分叉的几何和血流规则扩展到了三叉分支，以确保适用于任何分支模式的最佳治疗缩放规则。
