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Relationships between coronary arteries and atrioventricular annuli: surgical and percutaneous implications

Fahd Bennani1,2, Alexandre Sebestyen3, Prune Grimont4

  • 1Cardiac Surgery Department, University Hospital Grenoble-Alpes, Boulevard de la Chantourne, CS10217, 38043 Cedex 09, Grenoble, France. FBennani@chu-grenoble.fr.

General Thoracic and Cardiovascular Surgery
|July 15, 2021
PubMed

Insights

Identifying high-risk zones near the mitral and tricuspid annuli is crucial for preventing myocardial infarction during valve surgery. This study maps these critical areas to guide interventionists and minimize ischemic complications.

Area of Science:

  • Cardiovascular Anatomy
  • Surgical Risk Assessment
  • Interventional Cardiology

Background:

  • Atrioventricular valve surgery and percutaneous interventions carry risks of myocardial infarction due to coronary artery proximity.
  • Understanding the spatial relationship between coronary arteries and heart valves is essential for patient safety.

Purpose of the Study:

  • To identify specific zones on the mitral and tricuspid annuli with high risk of coronary artery injury.
  • To provide precise anatomical data to aid surgeons and interventionalists in avoiding ischemic complications.

Main Methods:

  • Dissection of circumflex and right coronary arteries in 25 explanted human hearts.
  • Measurement of distances from coronary arteries to mitral and tricuspid annuli using a clock-face model.
  • Categorization of proximity into "very high" (<5 mm), "high" (5-10 mm), and "relative" (>10 mm).

Main Results:

  • The mitral annulus zone of high risk is between 7:30 and 10:00 (minimum 6.5 mm at 9:30).
  • The tricuspid annulus zone of very high risk is between 1:30 and 3:00 (minimum 4.0 mm at 2:00).
  • Left coronary dominance showed closer proximity of the circumflex artery to the mitral annulus.

Conclusions:

  • Defined "at-risk" zones on the mitral (7:30-10:00) and tricuspid (1:30-3:00) annuli for coronary damage.
  • Knowledge of these zones aids interventionists in preventing ischemic complications during valve procedures.
  • An innovative clock-face orientation scheme provides an intuitive overview of critical valve-artery distances.
Abstract

Keywords:
Anatomical studyAtrioventricular heart valveCoronary arteryIschemic complications

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