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Thorac Cardiovasc Surg 2022; 70(02): 087-092
DOI: 10.1055/s-0040-1715181
Original Cardiovascular

Real 3D Visualization of the Circumflex Artery Surrounding the Mitral Annulus

Bálint Fábián
1   Department of Anatomy, Histology and Embryology, Laboratory for Applied and Clinical Anatomy, Semmelweis University, Budapest, Hungary
,
András Osadczuk
2   Department of Cardiology, Szent Rafael Hospital, Zala County, Zalaegerszeg, Hungary
,
László Bárány
1   Department of Anatomy, Histology and Embryology, Laboratory for Applied and Clinical Anatomy, Semmelweis University, Budapest, Hungary
,
Gábor Baksa
1   Department of Anatomy, Histology and Embryology, Laboratory for Applied and Clinical Anatomy, Semmelweis University, Budapest, Hungary
,
Gergely Rácz
3   1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
,
Tamás Ruttkay 
1   Department of Anatomy, Histology and Embryology, Laboratory for Applied and Clinical Anatomy, Semmelweis University, Budapest, Hungary
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Abstract

Background The circumflex coronary artery is located close to the mitral annulus. Consequently, it is not immune to iatrogenic damage during mitral valve procedures. Our objective was to visualize the circumflex artery from a surgeon's point of view, emphasizing its proximity. Furthermore, comparing it to coronary angiograms might support preoperative planning.

Methods Ten adult human hearts preserved in 4% formaldehyde solution were investigated (left coronary artery injected with contrast agent). After performing coronary angiographies from LAO (left anterior oblique) 40/cranial 20, RAO (right anterior oblique) 10/cranial 40, and true lateral projections, anatomical preparations were performed. Images were captured throughout the full course of the circumflex coronary artery from multiple angles. Finally, the mean distances were measured in every 5 mm between the investigated artery and the annulus of the mitral valve.

Results Three-dimensional model of the circumflex coronary artery and its surroundings was successfully achieved from a left atrial surgical viewpoint. The main branches were identified on the coronary angiograms. The closest distance was measured under the region of the left auricle (2.02 ± 0.69 mm; 1–3.1 mm). Afterward, the circumflex artery was observed to make a loop away from the annular region.

Conclusion Our observations show correlation with previous anatomical studies and case reports addressing iatrogenic lesions on the circumflex coronary artery. Based on all these, we could determine a “danger zone” on the vessel. The simultaneous evaluation of the anatomical preparations and the angiograms might improve the acknowledgment of this vulnerable region serving to avoid any damage to the coronary artery.

Keywords

anatomy - mitral valve surgery - coronary artery

Disclosures

The authors declare outside interests were not involved in neither the collection, analysis, and interpretation of the data nor the design of the study. Furthermore, the authors had freedom to fully disclose all results. Finally, no grants were received from any funding agencies in the public, commercials, or not-for-profit sectors.


Authors' Contribution

B.F.: project development, data collection, data analysis, manuscript writing; A.O.: data collection, data analysis; L.B.: data collection, project development; G.B.: project development; G.R.: data collection; T.R.: project development, data collection, data analysis, manuscript writing.


Supplementary Material



Publication History

Received: 15 April 2020

Accepted: 29 May 2020

Article published online:
21 October 2020

© 2020. Thieme. All rights reserved.

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