Rottländer Dennis, Gödde Miriel, Degen Hubertus, Ögütcü Alev, Saal Martin, Haude Michael
Department of Cardiology, Rheinlandklinikum Neuss, Neuss, Germany.
Department of Cardiology, Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany.
Catheter Cardiovasc Interv. 2021 Dec 1;98(7):1393-1401. doi: 10.1002/ccd.29824. Epub 2021 Jun 25.
Coronary sinus (CS) based mitral annuloplasty using the Carillon device could be limited by compromise of the left circumflex artery (Cx).
Computed tomography (CT) might be a feasible tool for preprocedural planning of indirect mitral valve annuloplasty.
In a retrospective analysis, 25 patients underwent Carillon device implantation and received CT-angiography (CTA) analysis prior to CS based percutaneous mitral valve repair. We used a retrospective approach with preprocedural CTA and intraprocedural coronary sinus angiography (CSA) measurements to determine the CS to Cx distance at the occlusion or compression point or in the distal landing zone in absence of Cx compromise.
According to left coronary artery angiography, we identified 7 patients with Cx occlusion, 7 with Cx compression and 11 without Cx compromise. No difference in minimal CS to Cx distance between the three groups could be obtained. Also, neither distal CS diameter nor distal Carillon anchor size were related to Cx impingement. However, ROC analysis identified a CS to Cx distance of <8.6 mm specifically in the distal device landing zone to predict Cx compromise. Furthermore, CTA was accurate in assessing device length in comparison to CSA, but failed predicting Carillon device anchor size.
CTA derived CS to Cx distance in the device landing zone might be helpful to predict Cx occlusion during Carillon device implantation. Furthermore, CTA predicted CS length but not anchor size correctly. Therefore, CT-angiographic procedural planning might help improving the results of percutaneous CS-based mitral valve repair.
使用Carillon装置进行基于冠状静脉窦（CS）的二尖瓣环成形术可能会受到左旋支动脉（Cx）受累的限制。
计算机断层扫描（CT）可能是间接二尖瓣环成形术术前规划的一种可行工具。
在一项回顾性分析中，25例患者接受了Carillon装置植入，并在基于CS的经皮二尖瓣修复术前接受了CT血管造影（CTA）分析。我们采用回顾性方法，通过术前CTA和术中冠状静脉窦血管造影（CSA）测量，以确定在闭塞或压迫点处或在无Cx受累情况下的远端着陆区中CS与Cx之间的距离。
根据左冠状动脉造影，我们确定7例患者存在Cx闭塞，7例存在Cx压迫，11例无Cx受累。三组之间CS与Cx的最小距离无差异。此外，远端CS直径和远端Carillon锚定尺寸均与Cx受压无关。然而，ROC分析确定在远端装置着陆区中CS与Cx的距离<8.6 mm可特异性预测Cx受累。此外，与CSA相比，CTA在评估装置长度方面准确，但未能预测Carillon装置锚定尺寸。
在装置着陆区通过CTA得出的CS与Cx的距离可能有助于预测Carillon装置植入期间的Cx闭塞。此外，CTA正确预测了CS长度，但未正确预测锚定尺寸。因此，CT血管造影的手术规划可能有助于改善基于CS的经皮二尖瓣修复的结果。
