Beton O, Kaplanoglu H, Hekimoglu B, Yilmaz M B
Department of Cardiology, Heart Centre, University Hospital, Cumhuriyet University, Sivas, Turkey, Turkey.
Folia Morphol (Warsz). 2017;76(2):197-207. doi: 10.5603/FM.a2016.0059. Epub 2016 Oct 7.
An understanding of the left main coronary artery (LMCA) anatomy is important for accurate diagnosis and therapy. We aimed to investigate LMCA anatomy via 128-multisliced coronary computed-tomography-angiography (CCTA) in patients with normal LMCA.
A total of 201 CCTA studies were included in this study. Anatomical features of LMCA including cross-sectional areas of the LMCA ostial, LMCA distal, left anterior descending artery (LAD) ostial and left circumflex artery (LCX) ostial, and degree of tapering and LMCA bifurcation angles (BA) in the form of LMCA-LCX BA, LMCA-LAD BA, LAD-LCX BA at end-diastole and end-systole.
The mean age was 55 ± 11; 55.7% of patients were males. Right coronary artery was dominant in 173 (86.1%) patients. Mean LMCA length was 10.0 ± 4.5 mm. The mean values of LMCA ostial, LMCA distal, LAD ostial and LCX ostial areas were 18.2 ± 5.1 mm², 13.2 ± 4.0 mm², 9.0 ± 3.2 mm² and 7.6 ± ± 2.8 mm², respectively. LMCA ostial-distal area, LMCA distal-LAD ostial area and LMCA distal-LCX ostial area ratios were ≥ 1.44 - < 1.69 in 47 (23.4%), 53 (26.4%), 47 (23.4%) patients, respectively, and were ≥ 1.69 - < 1.96 in 19 (9.5%), 24 (11.9%), 40 (19.9%) patients respectively. Systolic motion modifies LMCA BAs; systolic motion begets an increment of LMCA-LAD angle in 72.6% of patients and decrement of LAD-LCX angle in 75.6% of patients. Patients with T-shaped LAD-LCX BA was shown to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher diastolic-to-systolic range (DSR) of LAD-LCX BA compared to patients with Y-shaped LAD-LCX BA.
LMCA with T-shaped distal BA was found to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher DSR of distal BA compared to patients with Y-shaped distal BA. These findings may provide useful information for LMCA bifurcation stenting or designing dedicated stents for LMCA.
了解左冠状动脉主干（LMCA）解剖结构对于准确诊断和治疗至关重要。我们旨在通过128层冠状动脉计算机断层扫描血管造影（CCTA）研究LMCA解剖结构正常的患者。
本研究共纳入201例CCTA研究。LMCA的解剖特征包括LMCA开口处、LMCA远端、左前降支动脉（LAD）开口处和左旋支动脉（LCX）开口处的横截面积，以及舒张末期和收缩末期LMCA的逐渐变细程度和LMCA分叉角度（BA），以LMCA-LCX BA、LMCA-LAD BA、LAD-LCX BA的形式表示。
平均年龄为55±11岁；55.7%的患者为男性。173例（86.1%）患者以右冠状动脉为主。LMCA平均长度为10.0±4.5mm。LMCA开口处、LMCA远端、LAD开口处和LCX开口处面积的平均值分别为18.2±5.1mm²、13.2±4.0mm²、9.0±3.2mm²和7.6±2.8mm²。LMCA开口处至远端面积、LMCA远端至LAD开口处面积和LMCA远端至LCX开口处面积的比值在47例（23.4%）、53例（26.4%）、47例（23.4%）患者中分别≥1.44 - <1.69，在19例（9.5%）、24例（11.9%）、40例（19.9%）患者中分别≥1.69 - <1.96。收缩期运动改变LMCA的BA；收缩期运动使72.6%的患者LMCA-LAD角度增加，75.6%的患者LAD-LCX角度减小。与Y形LAD-LCX BA患者相比，T形LAD-LCX BA患者的LMCA明显更长，LAD开口处面积更大，LCX开口处面积更大，LAD-LCX BA的舒张期与收缩期范围（DSR）更高。
与Y形远端BA患者相比，T形远端BA的LMCA明显更长，LAD开口处面积更大，LCX开口处面积更大，远端BA的DSR更高。这些发现可能为LMCA分叉支架置入或设计专门用于LMCA的支架提供有用信息。
