‘Move Branch’ Function

When a branch origin requires modification, the 'Move Branch' function can be selected after right-clicking on the branch in question, exposing the appearance for the proximal marginal seen in Figure 1. (Notice the branch location with respect to the 80% lesion.)

Figure 1.

If you wish to move the proximal marginal branch closer to the LM, place the mouse arrow on the branch between the first two nodes (Figure 2), click and hold the left mouse button, and drag the vessel to the desired new location (Figure 3).

(Notice that Reduced Flow Regions on the 17-segment circumferential polar plot and the APPROACH Jeopardy score in the upper right corner automatically changed to reflect the new side branch location with respect to the 80% lesion.)

It is important to keep the first node of the branch being moved within the boundaries of the parent vessel.

Figure 2.

This function is intended to alter a branch origin only, it does not change the myocardial distribution assigned to the branch.

(After the branch has been moved, it is possible to grab on to and move other nodes along the length of the artery to make a more favourable appearance and to avoid overlapping other vessels or disease elements.)

Figure 3.

Branch / Segment Configuration Options

The top portion of the menu exposed by left-clicking on a branch or segment to be altered provides a list of alternate configuration choices (Figure 4). (Try selecting each one to learn the configuration options.)

In this example, we have selected a configuration that branches proximally with symmetric arms. (Figure 5).

‘Branch Pair’ Options

The standard proximal, mid, and distal branch placements establish a fixed relationship between a branch and the myocardial regions supplied. (This will be described in greater detail in a future Tutorial).

Occasionally, however, pairs of branches can be seen within a given proximal, mid, or distal location. The 'Branching Option' menu presents an opportunity to portray these branch pairs within one region.

After a branch configuration is selected (e.g. the proximal diagonal in Figure 5), the 'Configuration' menu is again selected by right-clicking on the diagonal's right or proximal branch (Figure 6).

'Move Branch' is then selected, the mouse arrow is positioned and held with the left mouse button, and the proximal branch is moved to its new position in the proximal LAD (Figure 7).

This action effectively creates a second proximal diagonal, and the software then assumes that the two new branches now share equally the myocardial region supplied by the originally unbranched proximal diagonal.

Figure 7.

Edit Vessel Function

The last item on the configuration menu, 'Edit Vessel', opens a wide range of editing possibilities beyond the scope of this review. (For the most part, we advise that this option not be used unless you are unable to paint the picture that you want without employing this function.)

Once this item is selected, there are two submenus available: one is exposed when right-clicking on the branch or segment to be edited (Figure 8); the second is exposed by right-clicking beside the branch or segment (Figure 9).

You will note, when selecting the 'Click-on-Branch' option for free wall branches, each branch has sub-segments called 'Lines'.

The editing function selected is unique to the 'Line' highlighted. These edit functions are most useful when reflecting clinically important morphology, such as a RCA Shepherds Hook, tortuousity in a diseased segment, or angulation at a bifurcation lesion.

The menu exposed by right-clicking beside a branch or segment is primarily used to change the location of a surgical graft target if the default positions are not appropriate.

Importantly, in order to exit the 'Edit Vessel' mode, you need to select 'Exit', the last function on this submenu.