Department of Interventional Cardiology, Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute of New York, NY, USA.
Circ Cardiovasc Interv. 2009 Dec;2(6):557-64. doi: 10.1161/CIRCINTERVENTIONS.109.873281. Epub 2009 Nov 10.
Implantation of devices into the coronary sinus (CS)/great cardiac vein (GCV) to reshape the mitral annulus (MA) is being investigated, despite these structures not being within the same plane and coronary arteries frequently traversing between them. Furthermore, dynamic changes in their relationship have never been studied. We analyzed the CS/GCV dimensions and its relationship with the MA and the coronary arteries.
Of 390 consecutive computed tomography angiographies reviewed, 56 met the inclusion criteria. Mean age of the patients was 68.9 + or - 13.1 years (26.8% men). The dimensions of the CS/GCV and the distance between this structure and the MA were measured at 10 different spatial points along the CS/GCV trajectory and at 3 different time points along the cardiac cycle (phases 0%, 40%, and 75% of the RR interval) by using curved multiplanar reconstruction technique. The CS/GCV was larger in phase 40% than in phase 75% and was smallest in phase 0% (P<0.001). The distance between the CS/GCV and the MA was longest in phase 40% and shortest in phase 0% (P=0.013). The diameter of the MA was measured in oblique 2- and 4-chamber reconstructions, being largest in phase 0% and smallest in phase 40% (P=0.019). A coronary artery traversed between the CS/GCV and the MA in 85.7% of the patients.
This study demonstrated dynamic changes in the relationship between the CS/GCV and the MA and also that coronary arteries frequently traverse between both structures. Whether these findings are of clinical relevance for patients undergoing percutaneous mitral annuloplasty needs to be prospectively evaluated.
尽管冠状窦（CS）/大心脏静脉（GCV）不在同一平面内，并且冠状动脉经常在它们之间穿行，但仍在研究将设备植入 CS/GCV 以重塑二尖瓣环（MA）的方法。此外，它们之间关系的动态变化从未被研究过。我们分析了 CS/GCV 的尺寸及其与 MA 和冠状动脉的关系。
在回顾的 390 例连续 CT 血管造影中，有 56 例符合纳入标准。患者的平均年龄为 68.9 ± 13.1 岁（26.8%为男性）。使用曲面多平面重建技术，在 CS/GCV 轨迹的 10 个不同空间点和心脏周期的 3 个不同时间点（RR 间隔的 0%、40%和 75%）测量 CS/GCV 的尺寸和该结构与 MA 之间的距离。CS/GCV 在 40%相位时大于 75%相位，在 0%相位时最小（P<0.001）。CS/GCV 与 MA 之间的距离在 40%相位时最长，在 0%相位时最短（P=0.013）。MA 的直径在斜 2 腔和 4 腔重建中测量，在 0%相位时最大，在 40%相位时最小（P=0.019）。在 85.7%的患者中，冠状动脉在 CS/GCV 和 MA 之间穿行。
本研究表明 CS/GCV 与 MA 之间的关系存在动态变化，并且冠状动脉经常在这两个结构之间穿行。这些发现是否对接受经皮二尖瓣环成形术的患者具有临床意义，需要前瞻性评估。
