Choure Arti J, Garcia Mario J, Hesse Barbara, Sevensma Matthew, Maly George, Greenberg Neil L, Borzi Lynn, Ellis Stephen, Tuzcu E Murat, Kapadia Samir R
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Am Coll Cardiol. 2006 Nov 21;48(10):1938-45. doi: 10.1016/j.jacc.2006.07.043. Epub 2006 Nov 1.
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.
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.
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).
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)
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.
我们试图利用心脏计算机断层扫描确定二尖瓣环（MA）与冠状窦（CS）以及CS与左旋支冠状动脉之间的体内解剖关系。
通过冠状窦进行瓣环成形术经皮治疗二尖瓣反流（MR）正在研发中。此类治疗的成功取决于MA与CS在解剖学上的紧密相邻。关于人类这种解剖关系的体内数据很少。我们使用对比增强多排探测器计算机断层扫描研究了这种关系。
我们研究了25名正常个体和11名因二尖瓣脱垂导致严重MR（3至4+）的患者。在标准平面，即四腔心（4C）、两腔心（2C）和三腔心视图中测量MA与CS之间的距离。使用三维映射（飞利浦Brilliance，飞利浦医疗系统公司，荷兰阿姆斯特丹）确定CS开口至与左旋支（LCX）交点的距离以及LCX与CS的解剖关系。
在所有平面上，CS与MA之间的距离存在显著差异。在MR组中，随着MA尺寸增加，CS与MA之间的距离在外侧位置（4C）增加，而在后方位置（2C）减小。80%的患者中左旋支动脉在CS和MA之间穿过。LCX在距CS开口可变距离处穿过CS（86.5±21mm，范围37至123mm）。
人类CS与MA之间的关系存在显著变异性。严重MR和瓣环扩张患者中，冠状窦至MA的距离增加，主要在左后外侧位置。大多数情况下左旋支在CS下方穿过，但它穿过CS的位置存在显著变异性。在选择二尖瓣修复的经皮治疗策略时应考虑这些解剖特征。
