Gopal Ambarish, Shah Atman, Shareghi Shahrzad, Bansal Neeraj, Nasir Khurram, Gopal Deepika, Budoff Matthew J, Shavelle David M
Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, California, USA.
J Invasive Cardiol. 2010 Feb;22(2):67-73.
The coronary sinus (CS) travels in close proximity to the left circumflex (LCX) artery. Percutaneously placed CS devices used to treat mitral regurgitation (MR) therefore have the potential to impinge upon the LCX arterial distribution and compromise coronary flow.
In this study, we sought to analyze the anatomic relationship between the CS, LCX and mitral annulus (MA) in patients with right dominant (RCD), left dominant (LCD) and codominant (CCD) arterial systems using a novel systematic approach.
We retrospectively studied 102 normal patients (46 females) and 27 consecutive patients (5 females) with ischemic severe MR. All patients underwent cardiovascular computed tomographic (CCT) angiography with a 64 multidetector scanner for clinical indications. Images were analyzed using a GE Advantage workstation, version 4.4, capable of advanced image processing and manipulation.
In patients with a normal mitral valve, the LCX initially crossed under the coronary sinus/great cardiac vein (CS/GCV) in 74% with RCD, 83% with LCD and 97% with CCD. In patients with ischemic severe MR, the LCX initially crossed under the CS/GCV in 96%.
The majority of patients, especially those with a CCD, have the LCX initially coursing under the CS/GCV. CCT data analysis using our newly established method is an excellent tool to evaluate the anatomic course of the LCX in patients being evaluated for percutaneous CS device placement.
冠状静脉窦（CS）紧邻左旋支（LCX）动脉走行。因此，用于治疗二尖瓣反流（MR）的经皮放置的CS装置有可能影响LCX动脉分布并损害冠状动脉血流。
在本研究中，我们试图使用一种新的系统方法分析右优势（RCD）、左优势（LCD）和共优势（CCD）动脉系统患者的CS、LCX与二尖瓣环（MA）之间的解剖关系。
我们回顾性研究了102例正常患者（46例女性）和27例连续的缺血性严重MR患者（5例女性）。所有患者均因临床指征接受了64排多层螺旋CT心血管造影检查。使用能够进行高级图像处理和操作的GE Advantage工作站4.4版对图像进行分析。
在二尖瓣正常的患者中，RCD患者中74%、LCD患者中83%、CCD患者中97%的LCX最初在冠状静脉窦/大心静脉（CS/GCV）下方穿过。在缺血性严重MR患者中，96%的LCX最初在CS/GCV下方穿过。
大多数患者，尤其是CCD患者，LCX最初走行于CS/GCV下方。使用我们新建立的方法进行CCT数据分析是评估接受经皮CS装置置入评估患者的LCX解剖走行的优秀工具。
