Coronary sinus is dilated and outwardly displaced in patients with mitral regurgitation: quantitative angiographic analysis.
OBJECTIVE
Our aim was to define the anatomy of the coronary sinus (CS) by venography. These measurements are essential in the selection of physical characteristics of percutaneous annuloplasty devices for mitral regurgitation (MR).


BACKGROUND
Clinical trials of percutaneous annuloplasty of the CS for MR are now underway. Although the CS is in close proximity to the mitral annulus, there is as yet no published quantitative data defining the magnitude of change in CS dimensions in MR, and how these changes might reflect the magnitude of MR.


METHODS
We studied 57 patients (27 patients with MR and 30 patients with no MR) who were referred for cardiac resynchronization therapy and underwent CS venography. Echocardiography was used to assess the degree of MR, cardiac dimensions, and right heart filling pressures. The diameter of the ostial and proximal CS and perimeter of the CS-great cardiac vein (GCV) were assessed by quantitative coronary analysis.


RESULTS
Patients with MR had a larger ostial CS diameter (19.4+/-3.9 mm vs. 16.9+/-4.6 mm, P=0.02) and proximal CS diameter (8.2+/-1.7 mm vs. 7.4+/-2.3 mm, P=0.05) and larger CS-GCV perimeter (104.4+/-15.6 mm vs. 86.5+/-15.3 mm, P=0.005) compared with patients with no MR. The CS-GCV perimeter is positively correlated to the severity of MR (P=0.02) and pulmonary artery pressure (r=0.32, P<0.05).


CONCLUSIONS
Patients with MR have a dilated and outward displacement of the CS. The CS-GCV perimeter is positively correlated with the degree of MR and pulmonary artery pressure.
Cedars-Sinai Medical Center, and UCLA School of Medicine, Los Angeles, California, USA.
Michael S
MS
Lee
Atman P
AP
Shah
Ninh
N
Dang
Daniel
D
Berman
James
J
Forrester
Prediman K
PK
Shah
Joseph
J
Aragon
Faizi
F
Jamal
Raj R
RR
Makkar
D000704:Analysis of Variance; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D004108:Dilatation, Pathologic; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology; D011857:Radiographic Image Interpretation, Computer-Assisted