Objective

Atrioventricular valve surgery poses a risk of myocardial infarction due to the proximity of the coronary arteries. Percutaneous techniques also present a risk of coronary injury. Our objective was to identify, on the mitral and the tricuspid annuli, the zones of high risk given their proximity to the circumflex artery and the right coronary artery, respectively.

Methods

We dissected the courses of the circumflex artery and the right coronary artery in 25 explanted hearts. The distances were measured at reference points according to a clock-face model. Proximity was “very high”, “high”, or “relative” for distances of less than 5 mm, between 5 and 10 mm, or more than 10 mm, respectively.

Results

The mitral annulus zone of “high” proximity was located between “7:30” and “10:00” (minimum 6.5 mm at “9:30”). The tricuspid annulus zone of “very high” proximity was located between “1:30” and “3:00” (minimum 4.0 mm at “2:00”). The circumflex artery seemed closer to the mitral annulus in the hearts with left coronary dominance (n = 2), emphasizing the importance of the preoperative coronary angiography.

Conclusions

Zones at risk of coronary damage were identified on the mitral and the tricuspid annuli between “7:30” and “10:00”, and between “1:30” and “3:00”, respectively. Knowing them can help interventionists avoid ischemic complications. Based on an innovative clock-face orientation scheme in which the distance data were collected at multiple reference points on a superimposed template, our study provides an intuitive and detailed overview of the critical distances between valves and arteries.

中文翻译：

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冠状动脉和房室环之间的关系：手术和经皮影响

客观的

由于靠近冠状动脉，房室瓣手术存在心肌梗塞的风险。经皮技术也存在冠状动脉损伤的风险。我们的目标是在二尖瓣和三尖瓣环上识别高风险区域，因为它们分别靠近回旋动脉和右冠状动脉。

方法

我们在 25 颗移植心脏中解剖了回旋动脉和右冠状动脉的走行。根据钟面模型在参考点测量距离。对于小于 5 毫米、介于 5 和 10 毫米之间或大于 10 毫米的距离，接近度分别为“非常高”、“高”或“相对”。

结果

“高”接近的二尖瓣环区位于“7:30”和“10:00”之间（“9:30”时最小 6.5 mm）。“非常高”接近的三尖瓣环带位于“1:30”和“3:00”之间（“2:00”时最小 4.0 mm）。在左冠状动脉优势的心脏中，回旋动脉似乎更接近二尖瓣环（n  = 2），强调了术前冠状动脉造影的重要性。

结论

在“7:30”和“10:00”之间以及“1:30”和“3:00”之间分别在二尖瓣和三尖瓣环上识别出冠状动脉损伤风险区域。了解它们可以帮助干预者避免缺血性并发症。基于一种创新的钟面定向方案，在该方案中，距离数据是在叠加模板上的多个参考点处收集的，我们的研究提供了对瓣膜和动脉之间关键距离的直观而详细的概述。