Structure-function relation in the coronary artery tree: From fluid dynamics to arterial bifurcations

Coronary bifurcations are transitional junctions that allow the divergence of the system to nourish the myocardium. The apparent complexity of the tree consists of a self-similar pattern of branching (i.e., a fractal geometry), based on energetic efficiency (principle of minimum work for blood transport). The bifurcation is a strategic nexus of geometry, fluid dynamics and rheology. Atherogenesis, atherosclerosis, plaque vulnerability and thrombosis are closely associated with the geometric and fluid dynamics factors at the bifurcation. Moreover, stenting of bifurcations also may contribute to additional haemodynamic disturbances. Interventional management of bifurcations should therefore restore optimal flow and minimise further haemodynamic disturbances by obeying the rules of geometry and hence function.