How far is the left circumflex coronary artery from the mitral annulus?
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ORIGINAL ARTICLE
How far is the left circumflex coronary artery from the mitral annulus? Koji Miura1 · Tatsuhiko Komiya1 · Takeshi Shimamoto1 · Takehiko Matsuo1 Received: 28 May 2020 / Accepted: 11 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Introduction The relationship between the distance from the mitral annulus to the left circumflex coronary artery (LCX) and iatrogenic LCX injury has been questioned. This study was designed to determine the high-risk sites of LCX injury with an anatomical approach using multiple detector-computed tomography (MDCT) scanning taken before mitral valve annuloplasty (MVA). The purpose of this study is to prevent LCX injury in patients unable to receive MDCT before mitral valve surgery. Methods In 2018, we performed MVA on 59 patients, 52 of whom had undergone preoperative MDCT scanning. We retrospectively analyzed the MDCT images of these 52 patients and measured the shortest distance from the mitral annulus to the LCX in three dimensions. Also, we divided the mitral annulus into 12 clockwise areas (A0–A11) to identify the exact location. Results The site of closest proximity and their numbers of patients were as follows: A6, 1 patient; A8, 2 patients; A9, 32 patients; and A10, 17 patients. Nine (17.3%) of the 52 patients had the shortest distance of less than 2 mm. The shortest distance according to the dominance of coronary artery showed no significant difference (p = 0.81). Conclusion The site of closest proximity from the mitral annulus to the LCX was concentrated on the A8 to A10 areas and it is an interesting result that as many as 17% of patients have their coronary arteries less than 2 mm away from the annulus. Keywords Mitral valve annuloplasty · Left circumflex artery · Perioperative myocardial infarction · Iatrogenic injury · Coronary artery anatomy
Introduction Annuloplasty using a ring or band for mitral regurgitation due to valve prolapse prevents further expansion of the annulus, enabling the expansion of the leaflet junction area and remodeling of the mitral annulus [1–4]. Anatomically, the left circumflex coronary artery (LCX) runs along the mitral annulus in the atrioventricular groove [5], and the LCX and the mitral annulus are sometimes close to each other [6]. The MVA procedure has therefore a risk of LCX occlusion [3, 7–9]. In addition, with the widespread use of minimally invasive cardiac surgery, precise needle control in a limited field of view is required. Anomalous coronary artery [10, 11], the use of largesized rings, and the left dominant coronary artery are risk factors of coronary occlusion [7, 12–14]. Husain et al.
[15] confirmed a limit of predicting high-risk cases by the left–right dominance of coronary arteries. Previous studies on coronary artery occlusion after MVA were with a small number of subjects and based on the obstructed cases [3, 7, 12, 15]. Also, measurement was done with a limited number of specimens after death [2, 8] and after formalin fixation [6]. The impact of formalin fixation on the
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