In Vivo Analysis of the Anatomical Relationship of Coronary Sinus to Mitral Annulus and Left Circumflex Coronary Artery Using Cardiac Multidetector Computed Tomography: Implications for Percutaneous Coronary Sinus Mitral Annuloplasty

Objectives We sought to determine the in vivo anatomical relationships between mitral annulus (MA) and coronary sinus (CS) as well as CS and left circumflex coronary artery using cardiac computed tomography. Background Percutaneous treatment of mitral regurgitation (MR) by annuloplasty via CS is under development. Success of such treatment depends on the close anatomical proximity of the MA to the CS. The in vivo data regarding this anatomical relationship in humans are scant. We investigated this relationship using contrast multidetector computed tomography. Methods We studied 25 normal individuals and 11 patients with severe MR (3 to 4+) due to mitral valve prolapse. Separation between MA and CS was measured in standard planes, in 4-chamber (4C), 2-chamber (2C), and 3-chamber views. Distance from ostium of CS to the intersection with left circumflex (LCX), and anatomical relation of LCX and CS were determined using 3-dimensional mapping (Philips Brilliance, Philips Medical Systems, Amsterdam, the Netherlands). Results There was significant variance of CS to MA separation at all planes. Separation of CS and MA was increased in lateral location (4C) and decreased in posterior location (2C) in the MR group with increase in MA size. Left circumflex artery crossed between CS and MA in 80% of patients. The LCX crossed CS at a variable distance from the ostium of CS (86.5 ± 21 mm, range 37 to 123 mm) Conclusions There is significant variability in the relation of CS to MA in humans. Coronary sinus to MA distance increases in patients with severe MR and annular dilation, mainly in the posterolateral location. The left circumflex crosses under the CS the majority of times, but with a significant variability in the location where it crosses the CS. These anatomical features should be taken into consideration while selecting percutaneous treatment strategies for mitral valve repair. In Vivo Analysis of the Anatomical Relationship of Coronary Sinus to Mitral Annulus and Left Circumflex Coronary Artery Using Cardiac Multidetector Computed Tomography: Implications for Percutaneous Coronary Sinus Mitral Annuloplasty Arti J. Choure, Mario J. Garcia, Barbara Hesse, Matthew Sevensma, George Maly, Neil L. Greenberg, Lynn Borzi, Stephen Ellis, E. Murat Tuzcu, Samir R. Kapadia Percutaneous mitral annuloplasty for treatment of mitral regurgitation (MR) is under development. Success of annuloplasty depends on the close anatomical proximity of the coronary sinus (CS) to the mitral annulus (MA). We studied this anatomical relationship by contrast multidetector computed tomography in 25 normal individuals and 11 patients with MR due to mitral valve prolapse. Coronary sinus and separation was measured in 2-dimensional planes in standard 4-, 2-, and 3-chamber views. Coronary sinus and left circumflex artery (LCX) relationship was studied by 3-dimensional mapping. There is significant variability to CS and MA separation in all planes. The LCX crosses between the CS and MA in 80% of normal patients. Abbreviations: CS, coronary sinus; CT, computed tomography; LCX, left circumflex coronary artery; MA, mitral annulus; MDCT, multidetector computed tomography; MR, mitral regurgitation; MVP, mitral valve prolapse; MVR, mitral valve repair; 2C, 2 chamber; 3C, 3 chamber; 4C, 4 chamber