title: The role of cardiovascular computed tomographic angiography for coronary sinus mitral annuloplasty.
abstract: BACKGROUND
  The coronary sinus (CS) travels in close proximity to the left circumflex (LCX) artery. Percutaneously placed CS devices used to treat mitral regurgitation (MR) therefore have the potential to impinge upon the LCX arterial distribution and compromise coronary flow.
  
  
  OBJECTIVE
  In this study, we sought to analyze the anatomic relationship between the CS, LCX and mitral annulus (MA) in patients with right dominant (RCD), left dominant (LCD) and codominant (CCD) arterial systems using a novel systematic approach.
  
  
  METHODS
  We retrospectively studied 102 normal patients (46 females) and 27 consecutive patients (5 females) with ischemic severe MR. All patients underwent cardiovascular computed tomographic (CCT) angiography with a 64 multidetector scanner for clinical indications. Images were analyzed using a GE Advantage workstation, version 4.4, capable of advanced image processing and manipulation.
  
  
  RESULTS
  In patients with a normal mitral valve, the LCX initially crossed under the coronary sinus/great cardiac vein (CS/GCV) in 74% with RCD, 83% with LCD and 97% with CCD. In patients with ischemic severe MR, the LCX initially crossed under the CS/GCV in 96%.
  
  
  CONCLUSIONS
  The majority of patients, especially those with a CCD, have the LCX initially coursing under the CS/GCV. CCT data analysis using our newly established method is an excellent tool to evaluate the anatomic course of the LCX in patients being evaluated for percutaneous CS device placement.
authors.affiliation: Division of Cardiovascular Medicine, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Gopal
authors.forename: Atman
authors.initials: A
authors.lastname: Shah
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Shareghi
authors.forename: Neeraj
authors.initials: N
authors.lastname: Bansal
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Deepika
authors.initials: D
authors.lastname: Gopal
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: David M
authors.initials: DM
authors.lastname: Shavelle
mesh_terms: D000368:Aged; D002404:Catheterization / Q000379:methods*; D054326:Coronary Sinus / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*