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Magnetic Resonance Cardiac Vein Imaging

Relation to Mitral Valve Annulus and Left Circumflex Coronary Artery

Amedeo Chiribiri, MD^_*,, Sebastian Kelle, MD, Uwe Köhler, PhD, Laurens F. Tops, MD, Bernhard Schnackenburg, PhD^||, Rodolfo Bonamini, MD, Jeroen J. Bax, MD, Eckart Fleck, MD, Eike Nagel, MD, PhD^_*,_*

^_* King's College London BHF Centre of Research Excellence, Division of Imaging Sciences, St. Thomas's Hospital, King's College London, London, United Kingdom
Department of Internal Medicine, University of Torino, Torino, Italy
Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
^|| Philips Medical Systems, Hamburg, Germany

^_* Reprint requests and correspondence: Prof. Dr. Eike Nagel, King's College London, Division of Imaging Sciences, The Rayne Institute, 4th Floor Lambeth Wing, St. Thomas's Hospital, London SE1 7EH, United Kingdom (Email: eike.nagel{at}kcl.ac.uk).

Objectives: To evaluate in vivo anatomical relationships between the coronary sinus–great cardiac vein (CS–GCV), the mitral valve annulus (MVA), and left circumflex coronary artery (LCX) with cardiovascular magnetic resonance.

Background: The CS–GCV has become an anatomical structure of interest because it provides a way of access to the heart for a number of interventional procedures. Previous reports demonstrate that the postulated close anatomical proximity of the CS–GCV to the MVA does not always hold true in patients, both in autopsy specimens and in vivo by computed tomography.

Methods: In 31 participants (24 volunteers and 7 patients; 15 men; 42 ± 19 years), cardiovascular magnetic resonance was performed for noninvasive evaluation of the coronary sinus and of the coronary arteries using whole-heart imaging and intravascular contrast agents. Three-dimensional reconstructions, standard orthogonal planes, and unprocessed raw data were used to assess CS–GCV anatomy and its relation to the MVA and the LCX along their entire course.

Results: The CS–GCV was located behind the left atrium in all examined participants, at a minimum distance of 8.6 ± 3.9 mm from the MVA. In 80% of the participants, the LCX crossed the CS–GCV inferiorly, between the CS–GCV and the MVA. The CS–GCV and the LCX had a parallel course for 26.2 ± 23.0 mm, with great variability of location and length. In several participants, the CS–GCV had a long parallel course, but in other participants, the LCX crossed below the CS–GCV at a discrete point.

Conclusions: In all participants, the CS–GCV coursed behind the left atrium rather than behind the MVA. In the majority of the participants, the LCX coursed between the CS–GCV and the MVA. These anatomical relationships should be kept in mind when referring a patient for interventional procedures requiring the access to the CS–GCV, and cardiovascular magnetic resonance might provide important information for the selection of candidates for these procedures.

Key Words: intravascular contrast agents • mitral valve annulus • coronary sinus • left circumflex coronary artery • mitral valve repair • magnetic resonance imaging

Abbreviations and Acronyms   CMR = cardiac magnetic resonance   CS–GCV = coronary sinus and the great cardiac vein   LCX = left circumflex artery   MVA = mitral valve annulus   PMVA = percutaneous mitral valve annulus annuloplasty

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