Key result
Coronary sinus-mitral annulus distance changes dynamically across the cardiac cycle, with intervening arteries in ~86%.
Why the study?
Dynamic changes in the relationship between the coronary sinus/great cardiac vein and the mitral annulus have never been studied, despite their relevance for device implantation.
Observational (n=56)
p-value: p=0.013
The relationship between the coronary sinus/great cardiac vein and the mitral annulus changes dynamically during the cardiac cycle, with coronary arteries frequently traversing between them, highlighting important anatomical considerations for percutaneous mitral annuloplasty.
May complicate percutaneous mitral annuloplasty planning due to dynamic anatomy and frequent coronary interposition; leaves open optimal device strategies.
BACKGROUND: Implantation of devices into the coronary sinus (CS)/great cardiac vein (GCV) to reshape the mitral annulus (MA) is being investigated, despite these structures not being within the same plane and coronary arteries frequently traversing between them. Furthermore, dynamic changes in their relationship have never been studied. We analyzed the CS/GCV dimensions and its relationship with the MA and the coronary arteries. METHODS AND RESULTS: Of 390 consecutive computed tomography angiographies reviewed, 56 met the inclusion criteria. Mean age of the patients was 68.9 + or - 13.1 years (26.8% men). The dimensions of the CS/GCV and the distance between this structure and the MA were measured at 10 different spatial points along the CS/GCV trajectory and at 3 different time points along the cardiac cycle (phases 0%, 40%, and 75% of the RR interval) by using curved multiplanar reconstruction technique. The CS/GCV was larger in phase 40% than in phase 75% and was smallest in phase 0% (P<0.001). The distance between the CS/GCV and the MA was longest in phase 40% and shortest in phase 0% (P=0.013). The diameter of the MA was measured in oblique 2- and 4-chamber reconstructions, being largest in phase 0% and smallest in phase 40% (P=0.019). A coronary artery traversed between the CS/GCV and the MA in 85.7% of the patients. CONCLUSIONS: This study demonstrated dynamic changes in the relationship between the CS/GCV and the MA and also that coronary arteries frequently traverse between both structures. Whether these findings are of clinical relevance for patients undergoing percutaneous mitral annuloplasty needs to be prospectively evaluated.
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Valle-Fernández et al. (2009) reported an observational. Cardiac cycle phases was evaluated on Distance between the coronary sinus/great cardiac vein (CS/GCV) and the mitral annulus (MA) (p=0.013). The distance between the coronary sinus/great cardiac vein and the mitral annulus changes dynamically during the cardiac cycle (P=0.013), and a coronary artery traverses between them in 85.7% of patients.
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