Tops Laurens F, Van de Veire Nico R, Schuijf Joanne D, de Roos Albert, van der Wall Ernst E, Schalij Martin J, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Circulation. 2007 Mar 20;115(11):1426-32. doi: 10.1161/CIRCULATIONAHA.106.677880. Epub 2007 Mar 12.
Percutaneous mitral annuloplasty has been proposed as an alternative to surgical annuloplasty. In this respect, evaluation of the coronary sinus (CS) and its relation with the mitral valve annulus (MVA) and the coronary arteries is relevant. The feasibility of evaluating these issues noninvasively with multislice computed tomography was determined.
In 105 patients (72 men, age 59+/-11 years), 64-slice multislice computed tomography was performed for noninvasive evaluation of coronary artery disease. Thirty-four patients with heart failure and/or severe mitral regurgitation were included. Three-dimensional reconstructions and standard orthogonal planes were used to assess CS anatomy and its relation with the MVA and circumflex artery. In 71 patients (68%), the circumflex artery coursed between the CS and the MVA with a minimal distance between the CS and the circumflex artery of 1.3+/-1.0 mm. The CS was located along the left atrial wall, rather than along the MVA, in the majority of the patients (ranging from 90% at the level of the MVA to 14% at the level of the distal CS). The minimal distance between the CS and MVA was 5.1+/-2.9 mm. In patients with severe mitral regurgitation, the minimal distance between the CS and the MVA was significantly greater as compared with patients without severe mitral regurgitation (mean 7.3+/-3.9 mm versus 4.8+/-2.5 mm, P<0.05).
In the majority of the patients, the CS courses superiorly to the MVA. In 68% of the patients, the circumflex artery courses between the CS and the mitral annulus. Multislice computed tomography may provide useful information for the selection of potential candidates for percutaneous mitral annuloplasty.
经皮二尖瓣环成形术已被提议作为外科二尖瓣环成形术的替代方法。在这方面，评估冠状静脉窦（CS）及其与二尖瓣环（MVA）和冠状动脉的关系具有重要意义。本研究确定了使用多层螺旋CT无创评估这些问题的可行性。
对105例患者（72例男性，年龄59±11岁）进行了64层多层螺旋CT检查，以无创评估冠状动脉疾病。纳入了34例心力衰竭和/或严重二尖瓣反流患者。使用三维重建和标准正交平面评估CS的解剖结构及其与MVA和回旋支动脉的关系。在71例患者（68%）中，回旋支动脉走行于CS和MVA之间，CS与回旋支动脉之间的最小距离为1.3±1.0mm。在大多数患者中，CS位于左心房壁，而非沿着MVA（从MVA水平的90%到CS远端水平的14%不等）。CS与MVA之间的最小距离为5.1±2.9mm。与无严重二尖瓣反流的患者相比，严重二尖瓣反流患者CS与MVA之间的最小距离显著更大（平均7.3±3.9mm对4.8±2.5mm，P<0.05）。
在大多数患者中，CS走行于MVA上方。在68%的患者中，回旋支动脉走行于CS和二尖瓣环之间。多层螺旋CT可为经皮二尖瓣环成形术潜在候选者的选择提供有用信息。
