Does endoluminal 3D reconstruction of MRA improve the assessment of pulmonary vein ostial geometry compared to external 3D reconstruction in patients undergoing PV isolation?
Endoluminal 3D MRA reconstructions provide precise anatomical details of pulmonary vein ostia, suggesting that individual encircling of every PV during isolation should be discouraged due to narrow separating ridges.
INTRODUCTION: The detailed knowledge of the individual pulmonary vein (PV) anatomy may help to prevent serious complications during PV isolation (PVI). The purpose of this study was to determine the geometry of the PV ostia and their spatial relation to adjacent structures in external (ex 3D) and endoluminal (en 3D) three-dimensional reconstructions of magnetic resonance angiographies (MRAs). METHODS AND RESULTS: Ex 3D and en 3D of the left atrium (LA) and the PVs of 28 patients were calculated. Diameters and the shape of PV ostia were assessed. In addition, the distances between ipsilateral PV ostia, the LA isthmus line, the roof line and the distance between the left PV and the LA appendage (LAA) were measured. Both ex 3D and en 3D are useful tools to determine the dimensions and the geometry of PVs. En 3D facilitates the identification of common PV ostia (15/28 patients). In en 3D, ipsilateral PV ostia are separated by a narrow myocardial ridge of less than 4 mm in 19/38 PVs (mean 4.3 +/- 1 mm; 4.6 +/- 2 mm with ex 3D). LAA and the LPV ostia are separated by a ridge of less than 4 mm in 12/28 PVs measured with en 3D (4.8 +/- 2 mm; 6.4 +/- 2 mm with ex 3D). CONCLUSIONS: Both ex 3D and en 3D reconstructions of MRA precisely visualize the complex LA anatomy. Exact determination of PV ostial geometry is facilitated with en 3D and provides important anatomical information for the PVI strategy. According to our data, individual encircling of every PV is strongly discouraged.
Schmidt et al. (Wed,) studied this question.
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