Descriptive anatomy of the dominant septal perforators using dual source coronary CT angiography

Waleed Brinjikji, Scott R. Harris, Adam T. Froemming, Kevin N. Christensen, Nirusha Lachman, Philip A. Araoz

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Although clinical outcomes for septal ablation in treating left ventricular outflow tract obstructions are generally favorable, a variety of complications have been reported including a high incidence of right bundle branch block. These complications may be attributed to anatomic variability of the dominant septal perforator. We used Dual Source CT Coronary Angiography (DS-CTA) to determine the location of the termination point of the dominant septal perforator as well as the distance of the termination point from the mitral annulus in patients undergoing DS-CTA. One-hundred-fourteen DS-CTA scans were retrospectively reviewed by two observers by consensus. The left ventricle was divided into anterior wall, anterioseptum, and inferioseptum. For each segment, the myocardium was divided into three layers (1) right ventricular side, (2) mid portion, and (3) left ventricular side. The zone of termination of the dominant septal perforator was identified as well as the distance of the termination point from the mitral annulus. The dominant septal perforator terminated in the right ventricular side of the anterioseptum in 86 of the 118 visualized terminations (73%) and in the left ventricular anterior wall in 6 visualized terminations (5%). On average, the dominant septal perforator terminated 26.3 ± 8.6 mm from the mitral annulus. In the majority of cases, the dominant septal perforator terminates in the right ventricular side of anterioseptum. In addition, there is great variability in the distribution of the termination point of the dominant septal perforator from the mitral annulus.

Original languageEnglish (US)
Pages (from-to)70-78
Number of pages9
JournalClinical Anatomy
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2010

Keywords

  • CT angiography
  • Heart anatomy
  • Septal ablation
  • Septal perforators

ASJC Scopus subject areas

  • Anatomy
  • Histology

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