title: Coronary ostium topography: an implication for transcatheter aortic valve implantation?
abstract: OBJECTIVE
  Shorter distances from coronary ostia to the calcified aortic valve may result in occlusion with potential infarction during transcatheter aortic valve implantation. We hypothesized that preoperative CT-scan measurements might predict coronary occlusion.
  
  
  METHODS
  Distances from the coronary ostia to the calcified aortic valve were measured during open heart aortic valve replacement in 60 consecutive patients. Distances were compared to preoperative CT-scan measurements evaluating distance of the coronary ostia as well (n = 15).
  
  
  RESULTS
  The distances of the lower lip of the left and the right coronary artery ostia measured from the aortic annulus were 14.7 ± 3.9 mm and 13.4 ± 4.0 mm, respectively. The left, right and noncoronary cusp heights were 13.9 ± 2.5 mm, 12.8 ± 3.0 mm and 13.3 ± 3.1 mm, respectively. Coronary ostia topography indicated variations from the middle to the noncoronary commissure in 40% for the left and 63% for the right coronary ostium. CT-scan based measurements resulted in a distance of 12.8 ± 3.5 mm for the left and 13.9 ± 4.0 mm for the right coronary ostium, compared to 14.2 ± 4.2 mm and 13.5 ± 4.3 mm measured intraoperatively. A mild correlation between both measurements could be observed (r = 0.374, P = 0.188, left and r = 0.46, P = 0.09, n = 15).
  
  
  CONCLUSIONS
  CT-scan-based measurements differed from the intraoperative measurements, however preoperative CT-scan evaluation may be a useful tool to identify patients with short distance of coronaries.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany. daniel.wendt@uk-essen.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Vivien
authors.initials: V
authors.lastname: Price
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.forename: Hilmar
authors.initials: H
authors.lastname: Kühl
authors.forename: Markus
authors.initials: M
authors.lastname: Kamler
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Orszulak
authors.forename: Andreas
authors.initials: A
authors.lastname: Melzer
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.forename: Paschalis
authors.initials: P
authors.lastname: Tossios
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D003331:Coronary Vessels / Q000033:anatomy & histology / Q000473:pathology*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D014057:Tomography, X-Ray Computed