CLINICAL RESEARCH: NON-INVASIVE CORONARY ANGIOGRAPHY
In Vivo Analysis of the Anatomical Relationship of Coronary Sinus to Mitral Annulus and Left Circumflex Coronary Artery Using Cardiac Multidetector Computed Tomography
Implications for Percutaneous Coronary Sinus Mitral Annuloplasty
Arti J. Choure, MD*,
Mario J. Garcia, MD, FACC*,
Barbara Hesse, MD*,
Matthew Sevensma, DO*,
George Maly, MD ,
Neil L. Greenberg, PhD*,
Lynn Borzi, RN, MBA*,
Stephen Ellis, MD, FACC*,
E. Murat Tuzcu, MD, FACC* and
Samir R. Kapadia, MD, FACC*,*
* Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Department of Radiology, Cleveland Clinic, Cleveland, Ohio.
Manuscript received January 30, 2006;
revised manuscript received June 13, 2006,
accepted July 3, 2006.
* Reprint requests and correspondence: Dr. Samir Kapadia, Department of Cardiovascular Medicine, Associate Professor of Medicine, Cleveland Clinic, 9500 Euclid Avenue/F25, Cleveland, Ohio 44195. (Email: kapadis{at}ccf.org).
OBJECTIVES: We sought to determine the in vivo anatomical relationships between mitral annulus (MA) and coronary sinus (CS) as well as CS and left circumflex coronary artery using cardiac computed tomography.
BACKGROUND: Percutaneous treatment of mitral regurgitation (MR) by annuloplasty via CS is under development. Success of such treatment depends on the close anatomical proximity of the MA to the CS. The in vivo data regarding this anatomical relationship in humans are scant. We investigated this relationship using contrast multidetector computed tomography.
METHODS: We studied 25 normal individuals and 11 patients with severe MR (3 to 4+) due to mitral valve prolapse. Separation between MA and CS was measured in standard planes, in 4-chamber (4C), 2-chamber (2C), and 3-chamber views. Distance from ostium of CS to the intersection with left circumflex (LCX), and anatomical relation of LCX and CS were determined using 3-dimensional mapping (Philips Brilliance, Philips Medical Systems, Amsterdam, the Netherlands).
RESULTS: There was significant variance of CS to MA separation at all planes. Separation of CS and MA was increased in lateral location (4C) and decreased in posterior location (2C) in the MR group with increase in MA size. Left circumflex artery crossed between CS and MA in 80% of patients. The LCX crossed CS at a variable distance from the ostium of CS (86.5 ± 21 mm, range 37 to 123 mm)
CONCLUSIONS: There is significant variability in the relation of CS to MA in humans. Coronary sinus to MA distance increases in patients with severe MR and annular dilation, mainly in the posterolateral location. The left circumflex crosses under the CS the majority of times, but with a significant variability in the location where it crosses the CS. These anatomical features should be taken into consideration while selecting percutaneous treatment strategies for mitral valve repair.
|
Abbreviations and Acronyms
| | CS = coronary sinus | | CT = computed tomography | | LCX = left circumflex coronary artery | | MA = mitral annulus | | MDCT = multidetector computed tomography | | MR = mitral regurgitation | | MVP = mitral valve prolapse | | MVR = mitral valve repair | | 2C = 2 chamber | | 3C = 3 chamber | | 4C = 4 chamber |
|
This article has been cited by other articles:
|
|
|
|
 
J.-H. Kim, O. Kocaturk, C. Ozturk, A. Z. Faranesh, M. Sonmez, S. Sampath, C. E. Saikus, A. H. Kim, V. K. Raman, J. A. Derbyshire, et al.
Mitral cerclage annuloplasty, a novel transcatheter treatment for secondary mitral valve regurgitation: initial results in swine.
J. Am. Coll. Cardiol.,
August 11, 2009;
54(7):
638 - 651.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. E. Ruiz and I. Kronzon
The Wishful Thinking of Indirect Mitral Annuloplasty: Will It Ever Become a Reality?
Circ Cardiovasc Interv,
August 1, 2009;
2(4):
271 - 272.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Sack, P. Kahlert, L. Bilodeau, L. A. Pierard, P. Lancellotti, V. Legrand, J. Bartunek, M. Vanderheyden, R. Hoffmann, P. Schauerte, et al.
Percutaneous Transvenous Mitral Annuloplasty: Initial Human Experience With a Novel Coronary Sinus Implant Device
Circ Cardiovasc Interv,
August 1, 2009;
2(4):
277 - 284.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. P. Agarwal, P. N. Cascade, and F. Pagani
Novel Treatment Options for Chronic Heart Failure: A Radiologist's Perspective
Am. J. Roentgenol.,
July 1, 2009;
193(1):
W14 - W24.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Piazza, A. Asgar, R. Ibrahim, and R. Bonan
Transcatheter Mitral and Pulmonary Valve Therapy
J. Am. Coll. Cardiol.,
May 19, 2009;
53(20):
1837 - 1851.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-B. Masson and J. G. Webb
Percutaneous Treatment of Mitral Regurgitation
Circ Cardiovasc Interv,
April 1, 2009;
2(2):
140 - 146.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R D Christofferson, S R Kapadia, V Rajagopal, and E M Tuzcu
Emerging transcatheter therapies for aortic and mitral disease
Heart,
January 15, 2009;
95(2):
148 - 155.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Sorajja, R. A. Nishimura, J. Thompson, and K. Zehr
A Novel Method of Percutaneous Mitral Valve Repair for Ischemic Mitral Regurgitation
J. Am. Coll. Cardiol. Intv.,
December 1, 2008;
1(6):
663 - 672.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Chiribiri, S. Kelle, U. Kohler, L. F. Tops, B. Schnackenburg, R. Bonamini, J. J. Bax, E. Fleck, and E. Nagel
Magnetic resonance cardiac vein imaging: relation to mitral valve annulus and left circumflex coronary artery.
J. Am. Coll. Cardiol. Img.,
November 1, 2008;
1(6):
729 - 738.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Siminiak and J. Lipiecki
Trans-Coronary-Venous Interventions
Circ Cardiovasc Interv,
October 1, 2008;
1(2):
134 - 142.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Akiyama, Z. B. Popovic, K. Kamohara, F. Cingoz, M. Daimon, C. Ootaki, Y. Ootaki, M. Martin, J. Liu, M. W. Kopcak Jr, et al.
Acute Reduction of Functional Mitral Regurgitation in Canine Model Using an Epicardial Device
Ann. Thorac. Surg.,
May 1, 2008;
85(5):
1771 - 1775.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Plass, I. Valenta, O. Gaemperli, P. Kaufmann, H. Alkadhi, G. Zund, J. Grunenfelder, and M. Genoni
Assessment of coronary sinus anatomy between normal and insufficient mitral valves by multi-slice computertomography for mitral annuloplasty device implantation
Eur. J. Cardiothorac. Surg.,
April 1, 2008;
33(4):
583 - 589.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W.M. Fedak, P. M. McCarthy, and R. O. Bonow
Evolving Concepts and Technologies in Mitral Valve Repair
Circulation,
February 19, 2008;
117(7):
963 - 974.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Mack
Percutaneous treatment of mitral regurgitation: so near, yet so far!
J. Thorac. Cardiovasc. Surg.,
February 1, 2008;
135(2):
237 - 239.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Lansac, I. Di Centa, N. Al Attar, D. Messika-Zeitoun, R. Raffoul, A. Vahanian, and P. Nataf
Percutaneous mitral annuloplasty through the coronary sinus: an anatomic point of view.
J. Thorac. Cardiovasc. Surg.,
February 1, 2008;
135(2):
376 - 381.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. F. Tops, S. C. Krishnan, J. D. Schuijf, M. J. Schalij, and J. J. Bax
Noncoronary applications of cardiac multidetector row computed tomography.
J. Am. Coll. Cardiol. Img.,
January 1, 2008;
1(1):
94 - 106.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. F. Tops, N. R. Van de Veire, J. D. Schuijf, A. de Roos, E. E. van der Wall, M. J. Schalij, and J. J. Bax
Noninvasive Evaluation of Coronary Sinus Anatomy and Its Relation to the Mitral Valve Annulus: Implications for Percutaneous Mitral Annuloplasty
Circulation,
March 20, 2007;
115(11):
1426 - 1432.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
