title: Pulmonary vein ostium geometry: analysis by magnetic resonance angiography.
abstract: BACKGROUND
  During a catheter ablation procedure for selective electrical isolation of pulmonary vein (PV) ostia, the size of these ostia is usually estimated using fluoroscopic angiography. This measurement may be misleading, however, because only the projected supero/inferior ostium diameters can be measured. In this study, we analyzed 3-dimensional magnetic resonance angiographic (MRA) images to measure the minimal and maximal cross-sectional diameter of PV ostia in relation to the diameter that would have been projected on fluoroscopic angiograms during a catheter ablation procedure.
  
  
  RESULTS
  In 42 patients with idiopathic atrial fibrillation who were scheduled for selective electrical isolation of PV ostia, the minimal and maximal diameters of these ostia were measured from 3-dimensional MRA images. Thereafter, these images were oriented in a 45 degrees right or left anterior oblique direction and the projected diameter of the PV ostia were measured again. The average ratio between maximal and minimal diameter was 1.5+/-0.4 for the left and 1.2+/-0.1 for the right pulmonary vein ostia. Because of the orientation and oval shape of especially the left pulmonary vein ostia, their minimal diameters were significantly smaller than the projected diameters.
  
  
  CONCLUSIONS
  Pulmonary vein ostia, especially those at the left, are oval with the short axis oriented approximately in the antero/posterior direction. Consequently, PV ostia may sometimes be very narrow despite a rather normal appearance on angiographic images obtained during a catheter ablation procedure.
authors.affiliation: Department of Cardiology, Heart Lung Center Utrecht, Utrecht, The Netherlands. fredwittkampf@mac.com
authors.forename: Fred H M
authors.initials: FH
authors.lastname: Wittkampf
authors.forename: Evert-Jan
authors.initials: EJ
authors.lastname: Vonken
authors.forename: Richard
authors.initials: R
authors.lastname: Derksen
authors.forename: Peter
authors.initials: P
authors.lastname: Loh
authors.forename: Birgitta
authors.initials: B
authors.lastname: Velthuis
authors.forename: Eric F D
authors.initials: EF
authors.lastname: Wever
authors.forename: Lucas V A
authors.initials: LV
authors.lastname: Boersma
authors.forename: Benno J
authors.initials: BJ
authors.lastname: Rensing
authors.forename: Maarten-Jan
authors.initials: MJ
authors.lastname: Cramer
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D017115:Catheter Ablation; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery