title: Influence of left atrial and ventricular volumes on the relation between mitral valve annulus and coronary sinus.
abstract: The aim of this study was to evaluate the anatomic relation between the coronary sinus (CS), mitral annulus, and coronary arteries using 64-multislice computed tomography (MSCT) in patients presenting with a wide range of atrial volumes and left ventricular functions to determine the potential clinical use for percutaneous mitral annuloplasty (PMA). The MSCT data of 165 patients (age 63.65 +/- 12.89 years, 67.3% men) were evaluated. The following variables were measured: CS length, CS ostium area, area of the section of CS when it becomes great cardiac vein, area between CS and atrioventricular groove assessed in volume-rendered 3-dimensional images, axial angle measured as the angle between CS and mitral annulus assessed in axial section, mitral valve annulus (MVA) area, left atrium volume, and left circumflex artery/marginal branch-CS relation referring to mitral annulus. The correlation was inversed between the reduction of the axial angle and all following variables: enlargement of both left ventricular end-systolic (r = -0.429, p <0.001) and end-diastolic (r = -0.428, p <0.001) volumes, left atrial volume (r = -0.361, p <0.001), and MVA (r = -0.324, p <0.001). Similarly, there was inverse correlation between the reduction of the area between CS and atrioventricular groove, and enlargement of both left ventricular end-systolic (r = -0.376, p <0.001) and end-diastolic (r = -0.291, p <0.001) volumes, left atrial volume (r = -0.221, p = 0.001), and MVA (r = -0.155, p = 0.019). Of note, circumflex artery was located between CS and MVA in 77% of the patients, but in patients with severe mitral regurgitation CS crossed circumflex/marginal branch artery more frequently (97% of cases). In conclusion, a close proximity of the CS to the mitral annulus but also to circumflex artery is more likely to occur with left atrial and ventricular enlargement. Thus, MSCT should be considered as part of the selection process of potential candidate to PMA to avoid external compression of circumflex artery/marginal branch by the device.
authors.affiliation: Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorgente
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.forename: Cristina
authors.initials: C
authors.lastname: Conca
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Francesco F
authors.initials: FF
authors.lastname: Faletra
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Rinky
authors.initials: R
authors.lastname: Bhatia
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Pedrazzini
authors.forename: Elena
authors.initials: E
authors.lastname: Pasotti
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
mesh_terms: D000368:Aged; D054326:Coronary Sinus / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*