Plass Andre, Valenta Ines, Gaemperli Oliver, Kaufmann Philipp, Alkadhi Hatem, Zund Gregor, Grünenfelder Jürg, Genoni Michele
Clinic for Cardiovascular Surgery, University Hospital, Raemistr. 100, 8091 Zürich, Switzerland.
Eur J Cardiothorac Surg. 2008 Apr;33(4):583-9. doi: 10.1016/j.ejcts.2007.12.041. Epub 2008 Feb 5.
Latest techniques enable positioning of devices into the coronary sinus (CS) for mitral valve (MV) annuloplasty. We evaluate the feasibility of non-invasive assessment to determine CS anatomy and its relation to MV annulus and coronary arteries by multi-slice CT (MSCT) in normal and insufficient MV.
Fifty patients (33 males, 17 females, age 67+/-11 years) were studied retrospectively by 64-MSCT scans for anatomical criteria regarding CS and its relation to MV annulus and circumflex artery (CX). We included 24 patients with severe mitral insufficiency and 26 with no MV disease. Diameter of MV, of proximal and distal ostium of CS, length and volume of CS, angle between anterior interventricular vein (AIV) and CS, caliber change of CX before, under/over and after CS were analysed. Different anatomical correlations were demonstrated: distance of MV annulus to CS, CX to CS.
Diameter of proximal CS ostium was significantly larger in insufficient MV compared to normal MV (11+/-2.8 mm vs 9.9+/-2.5 mm; p<0.024). CS was significantly longer in patients with insufficient MV (125.4+/-17 mm vs 108.9+/-18 mm; p<0.003) with also significant differences in volume of CS (p<0.039). Significant difference in annulus diameter, 46.1+/-6mm (insufficient MV) versus 39.5+/-7.5 mm, p<0.004 was observed. Angle CS-AIV was 103.5+/-29 degrees (range 52 degrees -144 degrees ) in insufficient valves versus 118.2+/-24.5 degrees (range 73 degrees -166 degrees ) in normal valves with a tendency to higher angles in normal valves (p=0.06). Distance of MV annulus to CS measured 16+/-4.1/14.2+/-3.6 mm (insufficient/normal MV) without significant difference between groups. In 15 patients CX ran under CS. Eighty-four percent of these patients (13/15) show a decrease in CS caliber in the area of intersection. In 14 patients CS ran over and in one patient the diameter of the CS at intersecting region was smaller. In 16 patients no direct point of contact was visible, in five patients CX to CS positioning was not evaluable.
There is a significant anatomic difference between normal and insufficient MV, which might be the basis for any interventional approaches through the CS. Exact measurements of all structures and its anatomic correlations are possible with MSCT, which allows pre-interventional planning.
最新技术能够将装置置入冠状窦（CS）以进行二尖瓣（MV）瓣环成形术。我们评估多层螺旋CT（MSCT）对正常和功能不全的MV进行无创评估以确定CS解剖结构及其与MV瓣环和冠状动脉关系的可行性。
对50例患者（33例男性，17例女性，年龄67±11岁）进行回顾性研究，通过64层MSCT扫描观察CS的解剖学标准及其与MV瓣环和回旋支动脉（CX）的关系。我们纳入了24例重度二尖瓣功能不全患者和26例无MV疾病的患者。分析了MV直径、CS近端和远端开口直径、CS长度和容积、前室间静脉（AIV）与CS之间的夹角、CS之前、下方/上方及之后CX的管径变化。展示了不同的解剖学相关性：MV瓣环至CS的距离、CX至CS的距离。
与正常MV相比，功能不全的MV患者CS近端开口直径显著更大（11±2.8mm对9.9±2.5mm；p<0.0并在CS容积方面也存在显著差异（p<0.039）。观察到瓣环直径存在显著差异，46.1±6mm（功能不全的MV）对39.5±7.5mm，p<0.004。功能不全瓣膜患者CS-AIV夹角为103.5±29度（范围52度-144度），正常瓣膜患者为118.2±24.5度（范围73度-166度），正常瓣膜患者的夹角有增大趋势（p=0.06）。MV瓣环至CS的距离为测量值为16±4.1/键差异。在15例患者中，CX走行于CS下方。这些患者中有84%（13/15）在交叉区域CS管径减小。在14例患者中，CS走行于CX上方，1例患者交叉区域CS直径较小。在16例患者中未见直接接触点，5例患者CX与CS的位置关系无法评估。
正常和功能不全的MV之间存在显著的解剖学差异，这可能是通过CS进行任何介入治疗方法的基础。利用MSCT可以精确测量所有结构及其解剖学相关性，从而实现介入治疗前的规划。
