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[Aortic valve structures as landmarks for determining coronary artery ostia in transthoracic echocardiography]
T Wolloscheck1, J Zipfel, M A Konerding
1Institut für Anatomie, Johannes-Gutenberg-Universität Mainz.
Insights
Transthoracal echocardiography can visualize coronary artery origins. This non-invasive method, using aortic valve landmarks, shows promise for screening coronary artery disease.
Area of Science:
- Cardiovascular imaging
- Anatomical studies
- Non-invasive diagnostics
Background:
- Coronary arteries are occasionally visualized during transthoracal echocardiography.
- The potential of echocardiography as a non-invasive screening tool for coronary arteries is explored.
- Accurate and reproducible measurement of coronary artery origins is essential for this modality.
Purpose of the Study:
- To assess the feasibility of transthoracal echocardiography for non-invasive screening of coronary arteries.
- To evaluate the accuracy of echocardiographic measurements of coronary ostia topography.
- To determine the utility of aortic valve leaflets as landmarks for coronary ostia identification.
Main Methods:
- Morphometric analysis of coronary ostia topography in relation to the aortic valve.
- Examination of 20 embalmed cadavers and 50 patients undergoing transthoracal echocardiography.
- Utilizing aortic leaflet attachments as anatomical reference points.
Main Results:
- Coronary arterial orifices were consistently located eccentrically, shifted towards the non-coronary aortic sinus.
- Echocardiographic measurements of distances from coronary ostia to aortic valve commissures and attachments showed good correlation with anatomical data.
- The average ostia location was 3.9 mm below the sinotubular junction, with multiple ostia observed in 65% of cases.
Conclusions:
- Aortic leaflet attachments serve as reliable landmarks in routine echocardiography.
- Coronary arterial orifices are identifiable in nearly all transthoracal echocardiography examinations.
- Transthoracal echocardiography demonstrates potential as a screening method for coronary artery disease.
Background:
Occasionally, coronary arteries are recorded in transthoracal echocardiography. The question was if this modality could be used as non-invasive screening method of the coronaries. A prerequisite for this is an exact and reproducible measurement of the origin of the coronary arteries.
Material And Method:
The topography of the coronary ostia in relation to the aortic valve was examined morphometrically in the aortae of 20 embalmed cadavers and 50 patients of a cardiologist's practice who underwent transthoracal echocardiography.
Results:
In all cases, the coronary arterial orifices were located eccentrically in the coronary sinus, shifted to the non-coronary aortic sinus. The distance between left coronary orifice to the commissure of the left and the right semilunar valvula was 13.3 mm on average in the anatomical measurements, whereas in the echocardiography this distance was 14.3 mm. The distance between the left ostium and the attachment of the left and the posterior semilunar valvula 9.4 mm, corresponding to 11.6 mm in echocardiography. The distance between right coronary orifice and the attachment of the right and the left semilunar valvula was 18.0 and 17.3 mm respectively, and the distance between right coronary orifice and the commissure of the right and the posterior semilunar valvula accounted for 8.5 and 9.7 mm respectively. On the average, the ostia were located 3.9 mm below the level of the sinotubular junction. Multiple ostia occurred in 65%, 92% of these were in the right coronary aortic sinus, shifted from the main orifice to the attachment of the right and the left semilunar valvula.
Conclusion:
In the cardiologist's routine, the attachments of the aortic leaflets proved to be very useful as landmarks. The coronary arterial orifices have been educible in nearly all cases. These results show that transthoracal echocardiography may be used in the screening for coronary artery disease.