Insight Into the Dynamics of the Coronary Sinus/Great Cardiac Vein and the Mitral Annulus

Abstract

Background-Implantation of devices into the coronary sinus (CS)/great cardiac vein (GCV) to reshape the mitral annulus (MA) is being investigated, despite these structures not being within the same plane and coronary arteries frequently traversing between them. Furthermore, dynamic changes in their relationship have never been studied. We analyzed the CS/GCV dimensions and its relationship with the MA and the coronary arteries. Methods and Results-Of 390 consecutive computed tomography angiographies reviewed, 56 met the inclusion criteria.Mean age of the patients was 68.9Ϯ13.1 years (26.8% men). The dimensions of the CS/GCV and the distance between this structure and the MA were measured at 10 different spatial points along the CS/GCV trajectory and at 3 different time points along the cardiac cycle (phases 0%, 40%, and 75% of the RR interval) by using curved multiplanar reconstruction technique. The CS/GCV was larger in phase 40% than in phase 75% and was smallest in phase 0% (PϽ0.001). The distance between the CS/GCV and the MA was longest in phase 40% and shortest in phase 0% (Pϭ0.013). The diameter of the MA was measured in oblique 2-and 4-chamber reconstructions, being largest in phase 0% and smallest in phase 40% (Pϭ0.019). A coronary artery traversed between the CS/GCV and the MA in 85.7% of the patients. Conclusions-This study demonstrated dynamic changes in the relationship between the CS/GCV and the MA and also that coronary arteries frequently traverse between both structures. Whether these findings are of clinical relevance for patients undergoing percutaneous mitral annuloplasty needs to be prospectively evaluated. (Circ Cardiovasc Interv. 2009;2:557-564.)

Prediction of fluoroscopic angulation and coronary sinus location by CT in the context of transcatheter mitral valve implantation

“…The ability to segment the coronary sinus in advance of the procedure through the use of MDCT is potentially of significant help as while the coronary sinus is commonly located along the atrial wall as opposed to the annular level in FMR patients, it exhibits significant inter-individual variability (10,13). This variability can be easily identified on pre-procedural CT allowing for more informed procedural planning in advance of the implantation.…”

Koroner Venöz Anatominin Multi Dedektör Bilgisayarlı Tomografi (MDBT) ile Değerlendirilmesi ve Klinik Önemi

“…Koroner sinüs orifisi atrezisinde venöz dönüş persistan sol süperior vena kava ile ya da kalp odacıklarına direkt (sol atriyum tabanındaki açıklıklar ile ya da atriyum içine KS dallarından) olur. Sol süperior vena kava ve KS atrezisi ile ilişkili diğer kardiyak lezyonlar atriyal septal defekt, ventriküler septal defekt, büyük damarların transpozisyonu, triküspit atrezi ve mitral atrezidir [32][33][34].…”

“…Her iki uçtaki çapalar, ortadaki köprü gerilip kısalırken proksimal koroner sinüsü ve ana kardiyak veni bir arada tutup çekerek, posteriyor mitral anülüsün öne doğru konumlanmasını ve böylelikle mitral anülüs çapı ile septal-lateral mesafenin azalmasını sağlayarak hastalığın progresyonunu önlerler [34,35]. Perkütan mitral anüloplasti açık kalp ameliyatının kontrendike olduğu, başlıca dilate iskemik veya non-iskemik kardiyomiyopatili, azalmış sol ventriküler ejeksiyon fraksiyonlu hastalarda, mitral regürjitasyonun palyatif tedavi yöntemidir [34,35]. Ayrıca PMA cihazının doğru konumlandırılması ve implante edilmesi için KS-BKV'in uzunluğu, çapları ve varyasyonları önemlidir.…”

“…Ayrıca PMA, KS koroner ven rüptürüne ve diseksiyonuna neden olabilir. Koroner sinüs ve koroner venler ince duvara sahip oldukları için hasar gördüklerinde tamir edilmesi oldukça güçtür [34,35]. Bundan dolayı işlem öncesi KS ve dallarının değerlendirilmesi, KRT ve PMA için çok önemlidir.…”

Spatial relationship of coronary sinus–great cardiac vein to mitral valve annulus and left circumflex coronary artery: implications for cardiovascular interventional procedures

“…Various in vivo imaging and cadaveric studies have provided quantitative information regarding the distance between the CS-GCV and MVA. The CS-GCV traverses behind posterior wall of left atrium at variable distances above the MVA plane(5,6,11,24,25).Percutaneous transvenous mitral annuloplasty in cases with CS-GCV coursing above the MVA might not reduce the mitral annular dimensions directly; instead, it may cinch the left atrial wall without annular re-shaping and reduce the effectiveness of the device(26).…”