Magnetic resonance cardiac vein imaging: relation to mitral valve annulus and left circumflex coronary artery.
OBJECTIVE
To evaluate in vivo anatomical relationships between the coronary sinus-great cardiac vein (CS-GCV), the mitral valve annulus (MVA), and left circumflex coronary artery (LCX) with cardiovascular magnetic resonance.


BACKGROUND
The CS-GCV has become an anatomical structure of interest because it provides a way of access to the heart for a number of interventional procedures. Previous reports demonstrate that the postulated close anatomical proximity of the CS-GCV to the MVA does not always hold true in patients, both in autopsy specimens and in vivo by computed tomography.


METHODS
In 31 participants (24 volunteers and 7 patients; 15 men; 42 +/- 19 years), cardiovascular magnetic resonance was performed for noninvasive evaluation of the coronary sinus and of the coronary arteries using whole-heart imaging and intravascular contrast agents. Three-dimensional reconstructions, standard orthogonal planes, and unprocessed raw data were used to assess CS-GCV anatomy and its relation to the MVA and the LCX along their entire course.


RESULTS
The CS-GCV was located behind the left atrium in all examined participants, at a minimum distance of 8.6 +/- 3.9 mm from the MVA. In 80% of the participants, the LCX crossed the CS-GCV inferiorly, between the CS-GCV and the MVA. The CS-GCV and the LCX had a parallel course for 26.2 +/- 23.0 mm, with great variability of location and length. In several participants, the CS-GCV had a long parallel course, but in other participants, the LCX crossed below the CS-GCV at a discrete point.


CONCLUSIONS
In all participants, the CS-GCV coursed behind the left atrium rather than behind the MVA. In the majority of the participants, the LCX coursed between the CS-GCV and the MVA. These anatomical relationships should be kept in mind when referring a patient for interventional procedures requiring the access to the CS-GCV, and cardiovascular magnetic resonance might provide important information for the selection of candidates for these procedures.
King's College London BHF Centre of Research Excellence, Division of Imaging Sciences, St. Thomas's Hospital, King's College London, London, United Kingdom.
Amedeo
A
Chiribiri
Sebastian
S
Kelle
Uwe
U
Köhler
Laurens F
LF
Tops
Bernhard
B
Schnackenburg
Rodolfo
R
Bonamini
Jeroen J
JJ
Bax
Eckart
E
Fleck
Eike
E
Nagel
D000328:Adult; D003198:Computer Simulation; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D054326:Coronary Sinus / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D008955:Models, Cardiovascular; D012189:Retrospective Studies; D014680:Veins / Q000473:pathology; D055815:Young Adult