Anatomical Proximity between Mitral Valve Annulus and Left Circumflex Artery – Implications to Mitral Valve Surgery

Abstract

Introduction: Mitral valve surgery raises the possibility of an acute myocardial infarction and iatrogenic injury to the left circumflex artery (LCX) which is closely tied to the mitral valve annulus (MVA)

Objectives: The objectives of this study is to develop a standardized anatomical distance from the LCX to the MVA and to better understand the relationship between coronary dominance and the LCX-MVA relationship in a clinically relevant setting.

Methods: 100 adult human hearts were obtained from the Forensic Department of Rajarajeshwari Medical College. The dominant pattern of the coronary arteries was analysed. Then left atriotomy was done, and three measurements were taken to determine MVA: anterior-posterior length, intercommissural length, and circumference. To report anatomical data in a clinically relevant context, a standardized clock face used in cardiothoracic surgery will be visually superimposed on the mitral valve annulus. The distance between LCX and MVA will thereafter be monitored every hour on the clock face where an artery is present.

Results: LCX was closest to MVA across all hearts at the P1 leaflet (8 o'clock) position. In right dominant hearts, the LCX was closest to the anterior commissure (10 o'clock) location. The left dominant heart's LCX was closer to the P3 leaflet (3 o'clock location). LCX was shown to be closest in left dominant arteries and female hearts.

Conclusions: This work improves awareness of the LCX-MVA interaction and reduces iatrogenic injury to LCX, allowing cardiac surgeons to avoid operational problems. This result validates earlier anatomical findings that left dominant hearts have a closer anatomical link with LCX and MVA