Chiribiri Amedeo, Kelle Sebastian, Köhler Uwe, Tops Laurens F, Schnackenburg Bernhard, Bonamini Rodolfo, Bax Jeroen J, Fleck Eckart, Nagel Eike
King's College London BHF Centre of Research Excellence, Division of Imaging Sciences, St. Thomas's Hospital, King's College London, London, United Kingdom.
JACC Cardiovasc Imaging. 2008 Nov;1(6):729-38. doi: 10.1016/j.jcmg.2008.06.009. Epub 2008 Nov 18.
To evaluate in vivo anatomical relationships between the coronary sinus-great cardiac vein (CS-GCV), the mitral valve annulus (MVA), and left circumflex coronary artery (LCX) with cardiovascular magnetic resonance.
The CS-GCV has become an anatomical structure of interest because it provides a way of access to the heart for a number of interventional procedures. Previous reports demonstrate that the postulated close anatomical proximity of the CS-GCV to the MVA does not always hold true in patients, both in autopsy specimens and in vivo by computed tomography.
In 31 participants (24 volunteers and 7 patients; 15 men; 42 +/- 19 years), cardiovascular magnetic resonance was performed for noninvasive evaluation of the coronary sinus and of the coronary arteries using whole-heart imaging and intravascular contrast agents. Three-dimensional reconstructions, standard orthogonal planes, and unprocessed raw data were used to assess CS-GCV anatomy and its relation to the MVA and the LCX along their entire course.
The CS-GCV was located behind the left atrium in all examined participants, at a minimum distance of 8.6 +/- 3.9 mm from the MVA. In 80% of the participants, the LCX crossed the CS-GCV inferiorly, between the CS-GCV and the MVA. The CS-GCV and the LCX had a parallel course for 26.2 +/- 23.0 mm, with great variability of location and length. In several participants, the CS-GCV had a long parallel course, but in other participants, the LCX crossed below the CS-GCV at a discrete point.
In all participants, the CS-GCV coursed behind the left atrium rather than behind the MVA. In the majority of the participants, the LCX coursed between the CS-GCV and the MVA. These anatomical relationships should be kept in mind when referring a patient for interventional procedures requiring the access to the CS-GCV, and cardiovascular magnetic resonance might provide important information for the selection of candidates for these procedures.
利用心血管磁共振评估冠状窦-大心静脉（CS-GCV）、二尖瓣环（MVA）和左旋支冠状动脉（LCX）之间的体内解剖关系。
CS-GCV已成为一个备受关注的解剖结构，因为它为多种介入手术提供了一种进入心脏的途径。既往报道表明，CS-GCV与MVA在解剖学上推测的紧密相邻关系在患者中并不总是成立，无论是在尸检标本中还是通过计算机断层扫描进行的体内研究。
对31名参与者（24名志愿者和7名患者；15名男性；42±19岁）进行心血管磁共振检查，使用全心成像和血管内造影剂对冠状窦和冠状动脉进行无创评估。利用三维重建、标准正交平面和未处理的原始数据，评估CS-GCV的解剖结构及其在整个行程中与MVA和LCX的关系。
在所有接受检查的参与者中，CS-GCV位于左心房后方，与MVA的最小距离为8.6±3.9 mm。在80%的参与者中，LCX在CS-GCV下方穿过，位于CS-GCV和MVA之间。CS-GCV和LCX有一段26.2±23.0 mm的平行行程，位置和长度变化很大。在一些参与者中，CS-GCV有较长的平行行程，但在其他参与者中，LCX在一个离散点处从CS-GCV下方穿过。
在所有参与者中，CS-GCV走行于左心房后方而非MVA后方。在大多数参与者中，LCX走行于CS-GCV和MVA之间。在为需要进入CS-GCV的介入手术转诊患者时，应牢记这些解剖关系，心血管磁共振可能为这些手术候选人的选择提供重要信息。
