Anatomic evaluation of 61 cadaveric hearts showed the coronary sinus is up to 19 mm (mean 9.7 mm) from the mitral annulus, with coronary branches located between them in up to 63.9% of cases.
Observational (n=61)
What is the anatomical relationship between the coronary sinus and the mitral valve annulus in human hearts, and what are the implications for percutaneous mitral annuloplasty?
The coronary sinus is located at a significant distance from the mitral valve annulus with intervening coronary arteries, suggesting percutaneous annuloplasty devices may only indirectly shrink the annulus and carry a risk of coronary compression.
BACKGROUND: To allow performance of "stand-alone" mitral annuloplasty with minimal invasiveness, percutaneous techniques consisting of delivery into the coronary sinus (CS) of devices intended to shrink the mitral valve annulus have recently been tested in animal models. These techniques exploit the anatomic proximity of the CS and mitral valve annulus in ovine or dogs. Knowledge of a detailed anatomic relationship between the CS, coronary arteries, and mitral valve annulus in humans is essential to define the safety and efficacy of percutaneous techniques in clinical practice. We sought to determine the qualitative and quantitative anatomic relationships between CS and surrounding structures in human hearts. METHODS AND RESULTS: The distance from the CS to the mitral valve annulus and the relationship between the CS and surrounding structures were studied in 61 excised cadaveric human hearts. Maximal distance from the CS to the mitral valve annulus was found to be up to 19 mm (mean, 9.7+/-3.2 mm). A diagonal or ramus branch, main circumflex artery, or its branches were located between anterior interventricular vein/CS and the mitral valve annulus in 16.4% and 63.9% of cases, respectively. CONCLUSIONS: Surgical anatomy suggests that in humans the CS is located behind the left atrial wall at a significant distance from the mitral valve annulus. Percutaneous mitral annuloplasty devices probably shrink the mitral valve annulus only by an indirect traction mediated by the left atrial wall; a theoretical risk of compressing coronary artery branches exists. Chronic studies are needed to address this problem and to determine long-term efficacy of such methods.
Maselli et al. (Tue,) conducted a observational in Anatomic relationship between coronary sinus and mitral valve annulus (n=61). Anatomic evaluation of 61 cadaveric hearts showed the coronary sinus is up to 19 mm (mean 9.7 mm) from the mitral annulus, with coronary branches located between them in up to 63.9% of cases.