Measurement of the Distance between the Mitral Annulus and the Left Circumflex Coronary Artery Using Multiplanar
Yuki Kuroda1,2, Yoshiharu Soga3, Takehiko Matsuo1
1Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, 803-8555, Japan.
Insights
The anatomical distance between the mitral annulus and the left circumflex coronary artery (LCX) is shorter in patients with mitral annular disjunction (MAD). Multiplanar reconstruction of transesophageal echocardiography images can identify this short distance.
Area of Science:
- Cardiovascular Imaging
- Cardiac Anatomy
- Echocardiography
Background:
- Mitral annular disjunction (MAD) is a complex condition affecting mitral valve function.
- Understanding the spatial relationship between the mitral annulus and the left circumflex coronary artery (LCX) is crucial for surgical safety.
- Transesophageal echocardiography (TEE) with multiplanar reconstruction (MPR) offers detailed anatomical visualization.
Purpose of the Study:
- To measure the anatomical distance between the mitral annulus and the LCX using MPR of TEE images.
- To investigate the association between this mitral-LCX (ML) distance and the presence of MAD.
Main Methods:
- Retrospective cohort study of 54 patients undergoing mitral valve repair.
- Measurement of the ML distance using intraoperative TEE-MPR.
- Comparison of ML distance between patients with MAD (n=11) and without MAD (n=43).
Main Results:
- The LCX is closest to the mitral annulus near the anterolateral commissure (70-90 degrees).
- Patients with MAD exhibited a significantly shorter minimum ML distance (3.2 mm) compared to those without MAD (4.9 mm).
- No LCX injuries were reported.
Conclusions:
- MPR of intraoperative TEE is a valuable, less invasive method to identify a short ML distance.
- A shorter ML distance, particularly near the anterolateral commissure, is associated with mitral annular disjunction.
Objectives:
We aimed to describe the anatomical distance between the mitral annulus and the left circumflex coronary artery (LCX) using multiplanar reconstruction (MPR) of transoesophageal echocardiography (TEE) images and to investigate its association with mitral annular disjunction (MAD).
Methods:
A single-centre retrospective cohort study included 54 patients who underwent mitral valve repair for mitral regurgitation between January 2020 and July 2021. We measured the distance between the mitral annulus and the LCX (ML distance) using MPR of intraoperative TEE images. As an exploratory analysis, we compared the ML distance between patients with MAD (group D: N = 11) and those without (group N: N = 43).
Results:
The LCX was closest to the mitral annulus at 70-90 degrees counterclockwise from the anteroposterior axis. No cases of LCX injury were observed. MAD was most frequently observed at P1, and all patients in group D had disjunction at P1. The minimum ML distance was significantly shorter in group D than in group N (3.2 [1.1] mm in group D, and 4.9 [2.1] mm in group N). Overall, the ML distance was shorter in group D than in group N, and was significantly shorter at 70-100 degrees.
Conclusions:
MPR of intraoperative TEE images is a less invasive and useful tool to detect patients with a short ML distance. The area of the closest distance from the mitral annulus to the LCX is near the anterolateral commissure, especially in patients with MAD.
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