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Computed tomography to identify risk factors for left circumflex artery injury during mitral surgery

Noriaki Kishimoto1, Yosuke Takahashi1, Hiromichi Fujii1

  • 1Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|October 15, 2021
PubMed

Insights

3D-CT imaging reveals the anatomical relationship between the left circumflex coronary artery (LCX) and the mitral annulus. This helps surgeons avoid LCX injury during mitral valve surgery by identifying the closest point (X point).

Area of Science:

  • Cardiovascular anatomy
  • Medical imaging
  • Surgical risk assessment

Background:

  • Proximity of the left circumflex coronary artery (LCX) to the mitral annulus poses a high risk of injury during mitral surgery.
  • Understanding this anatomical relationship is crucial for surgical planning and patient safety.

Purpose of the Study:

  • To investigate the anatomical relationship between the LCX and the mitral annulus using 3D computed tomography (CT).
  • To identify factors influencing the minimum distance (mCAD) between the LCX and the mitral annulus.

Main Methods:

  • 3D-CT images of the LCX and mitral annulus were constructed for 122 patients with mitral regurgitation.
  • Coronary dominance and mitral regurgitation aetiologies were classified.
  • The closest point (X point) and minimum distance (mCAD) were measured; atrioventricular disjunction was assessed.

Main Results:

  • The median minimum distance (mCAD) was 4.2 mm.
  • Shorter mCAD was observed in patients with left coronary dominance and Barlow's disease.
  • Left dominance and mitral annular disjunction were significant factors affecting mCAD.

Conclusions:

  • Superimposed 3D-CT images effectively visualize the LCX-mitral annulus relationship.
  • This imaging approach aids in preventing LCX injury during mitral valve surgery due to patient-specific variations in the X point.
Abstract

Keywords:
Computed tomographyCoronary artery injuryCoronary dominanceLeft circumflex coronary arteryMitral annular disjunctionMitral annulus

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