Relationship of mitral valve annulus plane and circumflex‐right coronary artery plane: Implications for transcatheter mitral valve implantation

• Published in: Catheterization and cardiovascular interventions Vol. 89; no. 5; pp. 932 - 943
• Main Authors: Kapadia, Samir R., Mentias, Amgad, Barakat, Amr F., Raza, Mohammad Q., Lal Poddar, Kanhaiya, Baeza, Cristian, Maluenda, Gabriel, Navia, Jose, Schoenhagen, Paul, Murat Tuzcu, E.
• Format: Journal Article
• Language: English
• Published: United States 01.04.2017
• Subjects: Aged, 80 and over; Anatomic Landmarks; Cardiac Catheterization - methods; cardiac computed tomography; Coronary Angiography - methods; Coronary Vessels - diagnostic imaging; Female; Fluoroscopy; Follow-Up Studies; Heart Valve Prosthesis Implantation - methods; Humans; Male; mitral valve; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; mitral valve imaging; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - surgery; Multidetector Computed Tomography - methods; Retrospective Studies; Surgery, Computer-Assisted - methods; transcatheter mitral valve implantation; mitral valve; transcatheter mitral valve implantation; mitral valve imaging; cardiac computed tomography
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26575

Aim Transcatheter mitral valve implantation (TMVI) is a novel technology for patients with severe mitral valve disease but at high surgical risk. Imaging guidance during the procedure is critical for successful device deployment. Identification of the mitral annular plane (MAP) with fluoroscopy during the procedure is limited by lack of clearly defined landmarks. We hypothesized that a plane defined by left circumflex‐right coronary arteries (LCX‐RCA) would have a consistent relationship to MAP. Methods and results We studied 25 patients with gated cardiac computed tomography. We identified the MAP and the LCX‐RCA plane in mid systole and diastole. The distance between the two planes in prespecified four points (anterior, posterior, medial, and lateral) in the apical 2 and 3‐chamber views. Alignment of the planes was described by cranial/caudal angulation for both planes in RAO 30° and LAO 90° (lateral) angulation. Mean age was 81 ± 9 years, 56% of patients had ≥2+ mitral regurgitation. In mid systole, the distances between the LCX‐RCA plane and the MAP in the four points were < 5 mm in 92% of patients. In mid diastole, distances were < 5 mm in 100% of patients. In mid systole, the correlation between the caudal/cranial orientations of the 2 planes was 0.85 and 0.80 in the LAO 90° and RAO 30°, respectively (P = <0.001). In mid diastole, this was 0.92 and 0.92 in the LAO 90° and RAO 30°, respectively (P = <0.001). Conclusion LCX‐RCA plane has a close and consistent relationship to the MAP and can be useful to guide TMVI. Accurate imaging of mitral valve annular plane during TMVI procedure is challenging. MAP guided by fluoroscopy might be crucial to guide successful prosthesis deployment. A plane defined by the left circumflex‐ right coronary arteries in the atrioventricular grove has a consistent relationship with MAP; this can be used aided by pre‐procedural MDCT to guide TMVI procedure. © 2016 Wiley Periodicals, Inc.