title: Optimal angulations for obtaining an en face view of each coronary aortic sinus and the interventricular septum: Correlative anatomy around the left ventricular outflow tract.
abstract: An optimal image intensifier angulation used for obtaining an en face view of a target structure is important in electrophysiologic procedures performed around each coronary aortic sinus (CAS). However, few studies have revealed the fluoroscopic anatomy of the target area. This study investigated the optimal angulation for each CAS and the interventricular septum (IVS). The study included 102 consecutive patients who underwent computed tomography coronary angiography. The optimal angle for each CAS was determined by rotating the volume-rendered image around the vertical axis. The angle formed between the anteroposterior axis and IVS was measured using the horizontal section. The frontal direction was defined as zero, positive, or negative if the en face view of the target CAS was obtained in the frontal view, left anterior oblique (LAO) direction, or right anterior oblique (RAO) direction, respectively. The optimal angles for the left, right, and non-CASs were 120.3 ± 10.5°, 4.8 ± 16.3°, and -110.0 ± 13.8°, respectively. The IVS angle was 42.6 ± 8.5°. Accordingly, the optimal image intensifier angulations for the left, right, and non-CASs and the IVS were estimated to be RAO 60°, LAO 5°, LAO 70°, and RAO 50°, respectively. The IVS angle was the most common independent predictor of the optimal angle for each CAS. Differences in the optimal angulations for each CAS and the IVS are demonstrated. The biplane angulation needs to be tailored according to the individual patients and target structures for electrophysiologic procedures.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Shumpei
authors.initials: S
authors.lastname: Mori
authors.forename: Koji
authors.initials: K
authors.lastname: Fukuzawa
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Takaya
authors.forename: Sachiko
authors.initials: S
authors.lastname: Takamine
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ito
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kinugasa
authors.forename: Mayumi
authors.initials: M
authors.lastname: Shigeru
authors.forename: Sei
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishii
authors.forename: Atsushi K
authors.initials: AK
authors.lastname: Kono
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshida
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging*; D054088:Ventricular Septum / Q000000981:diagnostic imaging*
keywords: coronary aortic sinus; en face view; fluoroscopic anatomy; image intensifier; interventricular septum; left ventricular outflow tract