title: The prevalence of coronary sinus and left circumflex artery overlap in relation to the mitral valve.
abstract: OBJECTIVE
  Characterize where the circumflex artery crosses between the coronary sinus and mitral valve in order to minimize the occurrence of coronary compression during percutaneous indirect mitral valve interventions.
  
  
  BACKGROUND
  Treatment of mitral valve regurgitation using an indirect percutaneous approach via access through the coronary sinus remains under active research and development. Characterization of anatomical locations where the circumflex artery crosses between the coronary sinus and mitral valve is important for mitigation of serious ischemic complications.
  
  
  METHODS
  Magnetic resonance images were obtained for 65 perfusion-fixed human hearts. Three-dimensional reconstructions of anatomical orientations of the coronary sinus, circumflex artery, and mitral valve annulus were generated. The prevalence and location of sites where the circumflex artery coursed between the coronary sinus and mitral valve were assessed.
  
  
  RESULTS
  The circumflex artery coursed between the coronary sinus and mitral valve in 88% of specimens. Overlaps between the circumflex artery and coronary sinus were less prevalent more proximal to the coronary sinus ostium. The coronary sinus did not lie in the same plane as the mitral annulus in roughly 20% of the hearts.
  
  
  CONCLUSIONS
  The prevalence of circumflex overlap between the coronary sinus and mitral valve was common across the sample size. The large variability in anatomy confirms the value of imaging individual patient cardiac anatomy prior to performing indirect percutaneous mitral valve annuloplasty to avoid impairment to the circumflex artery. This novel database can be utilized in the development of additional cardiac therapies that require access to the coronary sinus, such as therapeutic ablations.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Julianne H
authors.initials: JH
authors.lastname: Spencer
authors.forename: Garrett
authors.initials: G
authors.lastname: Prahl
authors.forename: Paul A
authors.initials: PA
authors.lastname: Iaizzo
mesh_terms: D000718:Anatomy, Regional / Q000379:methods; D054326:Coronary Sinus / Q000033:anatomy & histology*; D023921:Coronary Stenosis / Q000209:etiology / Q000517:prevention & control; D003331:Coronary Vessels / Q000033:anatomy & histology*; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008943:Mitral Valve / Q000033:anatomy & histology / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000379:methods; D008953:Models, Anatomic; D011183:Postoperative Complications / Q000517:prevention & control*