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Assessment of coronary sinus anatomy between normal and insufficient mitral valves by multi-slice computertomography for mitral annuloplasty device implantation

^a Clinic for Cardiovascular Surgery, University Hospital, Raemistr. 100, 8091 Zürich, Switzerland
^b Clinic for Nuclear Medicine, University Hospital, Zürich, Switzerland
^c Institute for Diagnostic Radiology, University Hospital, Zürich, Switzerland
^d Division of Experimental Surgery, University Hospital, Zürich, Switzerland

Received 4 September 2007; received in revised form 11 December 2007; accepted 19 December 2007.

^_* Corresponding author. Tel.: +41 44 2555 11 11; fax: +41 44 255 44 46. (Email: Andre.Plass{at}usz.ch).

Introduction: Latest techniques enable positioning of devices into the coronary sinus (CS) for mitral valve (MV) annuloplasty. We evaluate the feasibility of non-invasive assessment to determine CS anatomy and its relation to MV annulus and coronary arteries by multi-slice CT (MSCT) in normal and insufficient MV. Methods: Fifty patients (33 males, 17 females, age 67 ± 11 years) were studied retrospectively by 64-MSCT scans for anatomical criteria regarding CS and its relation to MV annulus and circumflex artery (CX). We included 24 patients with severe mitral insufficiency and 26 with no MV disease. Diameter of MV, of proximal and distal ostium of CS, length and volume of CS, angle between anterior interventricular vein (AIV) and CS, caliber change of CX before, under/over and after CS were analysed. Different anatomical correlations were demonstrated: distance of MV annulus to CS, CX to CS. Results: Diameter of proximal CS ostium was significantly larger in insufficient MV compared to normal MV (11 ± 2.8 mm vs 9.9 ± 2.5 mm; p < 0.024). CS was significantly longer in patients with insufficient MV (125.4 ± 17 mm vs 108.9 ± 18 mm; p < 0.003) with also significant differences in volume of CS (p < 0.039). Significant difference in annulus diameter, 46.1 ± 6 mm (insufficient MV) versus 39.5 ± 7.5 mm, p < 0.004 was observed. Angle CS–AIV was 103.5 ± 29° (range 52°–144°) in insufficient valves versus 118.2 ± 24.5° (range 73°–166°) in normal valves with a tendency to higher angles in normal valves (p = 0.06). Distance of MV annulus to CS measured 16 ± 4.1/14.2 ± 3.6 mm (insufficient/normal MV) without significant difference between groups. In 15 patients CX ran under CS. Eighty-four percent of these patients (13/15) show a decrease in CS caliber in the area of intersection. In 14 patients CS ran over and in one patient the diameter of the CS at intersecting region was smaller. In 16 patients no direct point of contact was visible, in five patients CX to CS positioning was not evaluable. Conclusion: There is a significant anatomic difference between normal and insufficient MV, which might be the basis for any interventional approaches through the CS. Exact measurements of all structures and its anatomic correlations are possible with MSCT, which allows pre-interventional planning.

Key Words: Coronary sinus • Mitral valve insufficiency • Multi-slice CT • Mitral valve annuloplasty device

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