Anatomy and Topography of Coronary Sinus and Mitral Valve Annulus in Functional Mitral Regurgitation

Figures

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  Figure 1. Assessment of coronary sinus to mitral valve annulus topography using a Multislice CT (MSCT) analysis prototype software. (A) Left: Semiautomatic tracking of the mitral valve annulus (MVA). Right: White dots indicate the tracked MVA. (B) Left: Tracking the coronary sinus (CS; yellow line). Right: MSCT showing the CS (blue line) entering the right atrium. Red line: MVA. (C) Left: 3D-model of MVA (red line, D-shape) and CS (blue line) showing their anatomical relation. Right: Centroid (red dot for MVA and blue dot for CS) and axis (red line for MVA and blue line for CS) of the MVA and CS. The normal vector is visualized by the horizontal dotted line. The sinus-mitral angle is located between the axes/normal vectors of the MVA and the CS. (D) Left: After MVA and CS reconstruction the prototype software calculates both distance and angulation of CS to MVA planes automatically. Right: Three-dimensional visualization allows evaluation of CS to MVA topography.

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  Figure 2. Echocardiographic evaluation of patients with and without functional mitral valve regurgitation. Left ventricular ejection fraction (LVEF) (A) and systolic pulmonary artery pressure (sPAP) (B) in patients with functional mitral regurgitation (FMR) ≥ 2+ or FMR ≤ 1+. Patients with FMR ≥ 2+ were separated according to a standard classification (FMR 2+, 3+, and 4+). (C) Quantitative echocardiographic assessment including measurement of vena contracta, proximal isovelocity surface area (PISA), effective regurgitant orifice area (EROA), and regurgitant volume in patients with FMR ≥ 2+. Mean ± SD.

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  Figure 3. Correlation of angulation and distance of CS to MVA planes with left ventricular ejection fraction left ventricular end-diastolic diameter and left atrial volume in patients with and without FMR. Correlation of angle (left) and distance (right) of the coronary sinus (CS) to mitral valve annulus (MVA) with (A) left ventricular ejection fraction (LVEF), (B) left ventricular end-diastolic diameter (LVEDD), and (C) left atrial (LA) volume in patients with FMR ≤ 1+. Correlation of angulation (left) and distance (right) of CS to MVA with (D) LVEF, (E) LVEDD, and (F) LA volume in patients with FMR ≥ 2+. R-values as indicated.

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  Figure 4. Coronary Sinus to Mitral Valve anatomy and topography in the presence and absence of FMR. (A) Gaussian function showing normal distribution of distance (left) and angulation (right) of CS to MVA planes (n = 215). (B) Total CS length in patients with FMR ≥ 2+ and FMR ≤ 1+. Correlation of distance and angulation of CS to MVA planes of patients with FMR ≤ 1+ (C) or FMR ≥ 2+ (D). (E) No difference between the distance of CS to MVA in patients with FMR ≤ 1+ or with FMR2+, FMR3+ or FMR4+. (F) No difference between angulation of CS to MVA in patients with FMR ≤ 1+ or with FMR2+, FMR3+ or FMR4+. Mean ± SD. *p < 0.05 vs. noFMR.

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  Figure 5. Dimensions of mitral valve annulus dimensions in patients with or without functional mitral regurgitation. (A) MSCT-derived parameters of mitral valve annulus dimensions (CC, intercommisural diameter; AP, anterior-posterior diameter; TT, trigone-to-trigone diameter) in a patient with FMR ≤ 1+ and with FMR ≥ 2+. (B,C) Mitral Valve Annulus (MVA) area, perimeter, anterior-posterior diameter and intercommisural diameter indexed to the Body Surface Area (BSA) in patients with FMR ≤ 1+ (n = 145) compared to FMR ≥ 2+ (n = 70) and the FMR subgroups (FMR2 +: n = 33, FMR3+: n = 24, FMR 4+: n = 13). *p <0.05 compared to FMR ≤ 1+; # p <0.05 compared to FMR2+.

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  Figure 6. Topography of coronary sinus to mitral valve annulus for percutaneous sinus-based mitral valve annuloplasty. Percentage of patients with favorable angle [ <14.2°, (A)] or distance [ <7.8 mm, (B)] of the coronary sinus to the mitral valve annulus. Percentage of favorable angle (C) or distance (D) according to FMR ≥ 2+ classes (FMR2+, FMR3+, or FMR4+).