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Magnetic resonance cardiac vein imaging: relation to mitral valve annulus and left circumflex coronary artery
Amedeo Chiribiri1, Sebastian Kelle, Uwe Köhler
1King's College London BHF Centre of Research Excellence, Division of Imaging Sciences, St. Thomas's Hospital, King's College London, London, United Kingdom.
Insights
Cardiovascular magnetic resonance shows the coronary sinus-great cardiac vein (CS-GCV) is behind the left atrium, not the mitral valve annulus (MVA). The left circumflex coronary artery (LCX) often passes between the CS-GCV and MVA, impacting interventional procedures.
Area of Science:
- Cardiovascular Imaging
- Cardiac Anatomy
- Interventional Cardiology
Background:
- The coronary sinus-great cardiac vein (CS-GCV) is crucial for cardiac interventional procedures.
- Previous studies suggest variable proximity of the CS-GCV to the mitral valve annulus (MVA).
Purpose of the Study:
- To delineate in vivo anatomical relationships between the CS-GCV, MVA, and left circumflex coronary artery (LCX).
- To assess the CS-GCV's position relative to the MVA and LCX using cardiovascular magnetic resonance (CMR).
Main Methods:
- 31 participants underwent CMR with whole-heart imaging and contrast agents.
- Three-dimensional reconstructions and standard planes were used to analyze CS-GCV, MVA, and LCX anatomy.
- Noninvasive assessment of anatomical relationships was performed.
Main Results:
- The CS-GCV consistently coursed posterior to the left atrium, with a mean minimum distance of 8.6 mm from the MVA.
- In 80% of participants, the LCX artery crossed inferiorly between the CS-GCV and MVA.
- Significant variability in the parallel course length between the CS-GCV and LCX was observed.
Conclusions:
- The CS-GCV is anatomically located behind the left atrium, not directly behind the MVA.
- The LCX artery frequently traverses the space between the CS-GCV and MVA.
- CMR provides vital anatomical insights for planning interventional procedures involving CS-GCV access.
Objectives:
To evaluate in vivo anatomical relationships between the coronary sinus-great cardiac vein (CS-GCV), the mitral valve annulus (MVA), and left circumflex coronary artery (LCX) with cardiovascular magnetic resonance.
Background:
The CS-GCV has become an anatomical structure of interest because it provides a way of access to the heart for a number of interventional procedures. Previous reports demonstrate that the postulated close anatomical proximity of the CS-GCV to the MVA does not always hold true in patients, both in autopsy specimens and in vivo by computed tomography.
Methods:
In 31 participants (24 volunteers and 7 patients; 15 men; 42 +/- 19 years), cardiovascular magnetic resonance was performed for noninvasive evaluation of the coronary sinus and of the coronary arteries using whole-heart imaging and intravascular contrast agents. Three-dimensional reconstructions, standard orthogonal planes, and unprocessed raw data were used to assess CS-GCV anatomy and its relation to the MVA and the LCX along their entire course.
Results:
The CS-GCV was located behind the left atrium in all examined participants, at a minimum distance of 8.6 +/- 3.9 mm from the MVA. In 80% of the participants, the LCX crossed the CS-GCV inferiorly, between the CS-GCV and the MVA. The CS-GCV and the LCX had a parallel course for 26.2 +/- 23.0 mm, with great variability of location and length. In several participants, the CS-GCV had a long parallel course, but in other participants, the LCX crossed below the CS-GCV at a discrete point.
Conclusions:
In all participants, the CS-GCV coursed behind the left atrium rather than behind the MVA. In the majority of the participants, the LCX coursed between the CS-GCV and the MVA. These anatomical relationships should be kept in mind when referring a patient for interventional procedures requiring the access to the CS-GCV, and cardiovascular magnetic resonance might provide important information for the selection of candidates for these procedures.
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