Types of anatomic relationship between left main coronary artery and pulmonary sinus of Valsalva: Implications for balloon pulmonary angioplasty and catheter ablation in the pulmonary root

Xiaonan Dong; Qi Sun; Min Tang; Shu Zhang

doi:10.1016/j.ijcard.2019.02.019

Types of anatomic relationship between left main coronary artery and pulmonary sinus of Valsalva: Implications for balloon pulmonary angioplasty and catheter ablation in the pulmonary root

Int J Cardiol. 2019 Aug 1:288:34-38. doi: 10.1016/j.ijcard.2019.02.019. Epub 2019 Apr 17.

Authors

Xiaonan Dong¹, Qi Sun¹, Min Tang², Shu Zhang¹

Affiliations

¹ Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: doctortangmin@hotmail.com.

PMID: 31029499
DOI: 10.1016/j.ijcard.2019.02.019

Abstract

Background: Concerns have been raised upon the risk of left main coronary artery (LMCA) injury when balloon angioplasty or ablation is performed within the pulmonary sinus of Valsalva (PSV).

Objective: To investigate the LMCA and PSV anatomic relationship (LMCA-PSV_ar) variants potentially susceptible to procedure complication.

Methods: We retrospectively studied 100 consecutive patients undergoing computed tomography coronary angiography (CTCA). Three types of LMCA-PSV_ar were observed on the basis of the relative location between the LMCA ostium and left pulmonary sinus of Valsalva (LPSV): type 1, intimate contact between the LMCA ostium and LSPV; type 2, LMCA ostium opposite to LPSV and the proximal part coursing anteriorly around LSPV; and type 3, no contact between LMCA ostium and LSPV.

Results: LMCA-PSV_ar types 1, 2, and 3 were present in 20(20%), 43(43%), and 37(37%) patients, respectively. For the three types of LMCA-PSV_ar, the minimal distance between LMCA and LPSV was 1.66 ± 0.53 mm, 4.63 ± 1.64 mm and 8.24 ± 1.65 mm, and the distance ≤5 mm were in 100%, 87% and 9% patients, respectively. Additionally, the distance from right coronary artery (RCA) to right pulmonary sinus of Valsalva (RPSV)/RVOT was ≤5 mm in 71 patients (71%).

Conclusion: The LMCA is intimately related to LPSV in majority of patients (mainly involving the types 1 and 2), whereas the RCA is often close to RPSV/RVOT. These anatomic features pose potential vulnerability to coronary injury, and should be heightened to avoid complications in this area.

Keywords: Ablation; Anatomy; Coronary artery; Pulmonary sinus of Valsalva.

MeSH terms

Angioplasty, Balloon / methods*
Catheter Ablation / methods*
Computed Tomography Angiography / methods
Coronary Angiography / methods
Coronary Vessels / diagnostic imaging*
Female
Follow-Up Studies
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Multidetector Computed Tomography / methods
Pulmonary Artery / diagnostic imaging
Pulmonary Artery / surgery*
Retrospective Studies
Sinus of Valsalva / diagnostic imaging*
Stenosis, Pulmonary Artery / diagnosis
Stenosis, Pulmonary Artery / surgery*
Vascular System Injuries / prevention & control