Author + information
- Received April 4, 2008
- Revision received June 13, 2008
- Accepted June 25, 2008
- Published online November 1, 2008.
- 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‡ and
- Eike Nagel, MD, PhD⁎,⁎ ()
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
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.
- intravascular contrast agents
- mitral valve annulus
- coronary sinus
- left circumflex coronary artery
- mitral valve repair
- magnetic resonance imaging
Financial support was received from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. Dr. Chiribiri is supported by a scholarship from the Italian Society of Cardiology.
- Received April 4, 2008.
- Revision received June 13, 2008.
- Accepted June 25, 2008.
- American College of Cardiology Foundation