Fábián Bálint, Osadczuk András, Bárány László, Baksa Gábor, Rácz Gergely, Ruttkay Tamás
Department of Anatomy, Histology and Embryology, Laboratory for Applied and Clinical Anatomy, Semmelweis University, Budapest, Hungary.
Department of Cardiology, Szent Rafael Hospital, Zala County, Zalaegerszeg, Hungary.
Thorac Cardiovasc Surg. 2022 Mar;70(2):87-92. doi: 10.1055/s-0040-1715181. Epub 2020 Oct 21.
The circumflex coronary artery is located close to the mitral annulus. Consequently, it is not immune to iatrogenic damage during mitral valve procedures. Our objective was to visualize the circumflex artery from a surgeon's point of view, emphasizing its proximity. Furthermore, comparing it to coronary angiograms might support preoperative planning.
Ten adult human hearts preserved in 4% formaldehyde solution were investigated (left coronary artery injected with contrast agent). After performing coronary angiographies from LAO (left anterior oblique) 40/cranial 20, RAO (right anterior oblique) 10/cranial 40, and true lateral projections, anatomical preparations were performed. Images were captured throughout the full course of the circumflex coronary artery from multiple angles. Finally, the mean distances were measured in every 5 mm between the investigated artery and the annulus of the mitral valve.
Three-dimensional model of the circumflex coronary artery and its surroundings was successfully achieved from a left atrial surgical viewpoint. The main branches were identified on the coronary angiograms. The closest distance was measured under the region of the left auricle (2.02 ± 0.69 mm; 1-3.1 mm). Afterward, the circumflex artery was observed to make a loop away from the annular region.
Our observations show correlation with previous anatomical studies and case reports addressing iatrogenic lesions on the circumflex coronary artery. Based on all these, we could determine a "danger zone" on the vessel. The simultaneous evaluation of the anatomical preparations and the angiograms might improve the acknowledgment of this vulnerable region serving to avoid any damage to the coronary artery.
回旋支冠状动脉靠近二尖瓣环。因此，在二尖瓣手术过程中它难免受到医源性损伤。我们的目的是从外科医生的角度可视化回旋支动脉，强调其邻近关系。此外，将其与冠状动脉造影进行比较可能有助于术前规划。
研究了10颗保存在4%甲醛溶液中的成人心脏（左冠状动脉注入造影剂）。在从左前斜位（LAO）40°/头位20°、右前斜位（RAO）10°/头位40°和真侧位进行冠状动脉造影后，进行了解剖学准备。从多个角度在回旋支冠状动脉的全程拍摄图像。最后，测量被研究动脉与二尖瓣环之间每5毫米的平均距离。
从左心房手术角度成功建立了回旋支冠状动脉及其周围的三维模型。在冠状动脉造影上识别出主要分支。在左心耳区域下方测得的最短距离为2.02±0.69毫米（1 - 3.1毫米）。之后，观察到回旋支动脉离开环形区域形成一个环。
我们的观察结果与先前关于回旋支冠状动脉医源性病变的解剖学研究和病例报告相关。基于所有这些，我们可以确定该血管上的一个“危险区域”。对解剖学准备和造影的同步评估可能会提高对这个易损区域的认识，有助于避免对冠状动脉造成任何损伤。
