open access

Vol 82, No 2 (2023)
Original article
Submitted: 2022-09-07
Accepted: 2022-10-31
Published online: 2022-11-28
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Topographical anatomy of the left ventricular summit: implications for invasive procedures

M. Kuniewicz12, M. Krupiński3, M. Urbańczyk-Zawadzka3, M. K. Hołda45, R. DeFonseka1, T. Wadhwa1, N. Cholewa1, A. Matuszyk1, J. Walocha1, H. Dobrzynski15
·
Pubmed: 36472400
·
Folia Morphol 2023;82(2):291-299.
Affiliations
  1. Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
  2. Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
  3. Department of Radiology and Diagnostic Imaging, John Paul II Hospital, Krakow, Poland
  4. HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Poland
  5. Division of Cardiovascular Sciences, The University of Manchester, United Kingdom

open access

Vol 82, No 2 (2023)
ORIGINAL ARTICLES
Submitted: 2022-09-07
Accepted: 2022-10-31
Published online: 2022-11-28

Abstract

Background: Recent clinical reports have emphasized the clinical significance of
the left ventricular summit (LVS), a specific triangular epicardial area, as the source
of ventricular arrhythmias where radiofrequency ablation is of great difficulty.
Materials and methods: The macroscopic morphology of the LVS has been assessed
in 80 autopsied and 48 angio-computed tomography (CT) human hearts.
According to Yamada’s equation, the size was calculated based on the distance
to the first, most prominent septal perforator.
Results: The size of the LVS varies from 33.69 to 792.2 mm2, is highly variable,
and does not correlate with body mass index, sex, or age in general. The mean
size of the LVS was 287.38 ± 144.95 mm2 in autopsied and angio-CT (p = 0.44).
LVS is mostly disproportionately bisected by cardiac coronary veins to superior-inaccessible
and inferior-accessible areas. The superior aspect dominates over the
inferior in both groups (p = 0.04). The relation between superior and inferior
groups determines three possible arrangements: the most common type is superior
domination (50.2%), then inferior domination (26.6%), and finally, equal
distribution (17.2%). In 10.9%, the inferior aspect is absent. Only 16.4% of the
LVS were empty, without additional trespassing coronary arteries.
Conclusions: The difference in size and content of the LVS is significant, with no
correlation to any variable. The size depends on the anatomy of the most prominent
septal perforator artery. The superior, inaccessible aspect dominates, and the LVS
is seldom free from additional coronary vessels, thus making this region hazardous
for electrophysiological procedures.

Abstract

Background: Recent clinical reports have emphasized the clinical significance of
the left ventricular summit (LVS), a specific triangular epicardial area, as the source
of ventricular arrhythmias where radiofrequency ablation is of great difficulty.
Materials and methods: The macroscopic morphology of the LVS has been assessed
in 80 autopsied and 48 angio-computed tomography (CT) human hearts.
According to Yamada’s equation, the size was calculated based on the distance
to the first, most prominent septal perforator.
Results: The size of the LVS varies from 33.69 to 792.2 mm2, is highly variable,
and does not correlate with body mass index, sex, or age in general. The mean
size of the LVS was 287.38 ± 144.95 mm2 in autopsied and angio-CT (p = 0.44).
LVS is mostly disproportionately bisected by cardiac coronary veins to superior-inaccessible
and inferior-accessible areas. The superior aspect dominates over the
inferior in both groups (p = 0.04). The relation between superior and inferior
groups determines three possible arrangements: the most common type is superior
domination (50.2%), then inferior domination (26.6%), and finally, equal
distribution (17.2%). In 10.9%, the inferior aspect is absent. Only 16.4% of the
LVS were empty, without additional trespassing coronary arteries.
Conclusions: The difference in size and content of the LVS is significant, with no
correlation to any variable. The size depends on the anatomy of the most prominent
septal perforator artery. The superior, inaccessible aspect dominates, and the LVS
is seldom free from additional coronary vessels, thus making this region hazardous
for electrophysiological procedures.

Get Citation

Keywords

left ventricular summit, septal summit, ventricular arrhythmias

About this article
Title

Topographical anatomy of the left ventricular summit: implications for invasive procedures

Journal

Folia Morphologica

Issue

Vol 82, No 2 (2023)

Article type

Original article

Pages

291-299

Published online

2022-11-28

Page views

2184

Article views/downloads

747

DOI

10.5603/FM.a2022.0096

Pubmed

36472400

Bibliographic record

Folia Morphol 2023;82(2):291-299.

Keywords

left ventricular summit
septal summit
ventricular arrhythmias

Authors

M. Kuniewicz
M. Krupiński
M. Urbańczyk-Zawadzka
M. K. Hołda
R. DeFonseka
T. Wadhwa
N. Cholewa
A. Matuszyk
J. Walocha
H. Dobrzynski

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