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The role of cardiovascular computed tomographic angiography for coronary sinus mitral annuloplasty
Ambarish Gopal1, Atman Shah, Shahrzad Shareghi
1Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, California, USA.
Insights
The left circumflex (LCX) artery often courses under the coronary sinus (CS), particularly in codominant (CCD) systems. Cardiovascular computed tomographic (CCT) angiography helps assess this relationship for percutaneous CS device placement.
Area of Science:
- Cardiovascular anatomy
- Interventional cardiology
- Medical imaging
Background:
- The coronary sinus (CS) runs near the left circumflex (LCX) artery.
- Percutaneous CS devices for mitral regurgitation (MR) may obstruct the LCX.
Purpose of the Study:
- To analyze the anatomic relationship between the CS, LCX, and mitral annulus (MA).
- To evaluate this relationship across different coronary artery dominance patterns (right, left, codominant).
Main Methods:
- Retrospective analysis of 102 normal and 27 severe ischemic MR patients.
- Cardiovascular computed tomographic (CCT) angiography using a 64 multidetector scanner.
- Image analysis on a GE Advantage workstation with advanced processing.
Main Results:
- In normal valves, LCX crossed under CS/great cardiac vein (GCV) in 74% (RCD), 83% (LCD), and 97% (CCD).
- In severe ischemic MR, 96% of LCX arteries crossed under the CS/GCV.
Conclusions:
- The LCX frequently courses under the CS/GCV, especially in codominant systems.
- CCT analysis is effective for evaluating LCX anatomy before percutaneous CS device implantation.
Background:
The coronary sinus (CS) travels in close proximity to the left circumflex (LCX) artery. Percutaneously placed CS devices used to treat mitral regurgitation (MR) therefore have the potential to impinge upon the LCX arterial distribution and compromise coronary flow.
Objectives:
In this study, we sought to analyze the anatomic relationship between the CS, LCX and mitral annulus (MA) in patients with right dominant (RCD), left dominant (LCD) and codominant (CCD) arterial systems using a novel systematic approach.
Methods:
We retrospectively studied 102 normal patients (46 females) and 27 consecutive patients (5 females) with ischemic severe MR. All patients underwent cardiovascular computed tomographic (CCT) angiography with a 64 multidetector scanner for clinical indications. Images were analyzed using a GE Advantage workstation, version 4.4, capable of advanced image processing and manipulation.
Results:
In patients with a normal mitral valve, the LCX initially crossed under the coronary sinus/great cardiac vein (CS/GCV) in 74% with RCD, 83% with LCD and 97% with CCD. In patients with ischemic severe MR, the LCX initially crossed under the CS/GCV in 96%.
Conclusions:
The majority of patients, especially those with a CCD, have the LCX initially coursing under the CS/GCV. CCT data analysis using our newly established method is an excellent tool to evaluate the anatomic course of the LCX in patients being evaluated for percutaneous CS device placement.
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