Anatomical relevance of ablation to the pulmonary artery root: Clinical implications for characterizing the pulmonary sinus of Valsalva and coronary artery.

Abstract

Ablation within the pulmonary sinus of Valsalva (PSV) becomes increasingly common in certain ventricular outflow arrhythmia. Understanding the regional anatomy is intensively concerned to avoid procedure complications. To describe the anatomic relationships of PSV to its adjacent structures using computed tomographic coronary angiograms (CTCA). We studied 145 patients (77 males, age 47±18years) investigated for chest pain with CTCA. The relationships between the PSV and adjacent structures were described by analysis of 2-dimensional images and 3-dimensional reconstructions. The left adjacent sinus (LAS) was located within 5mm of the left main coronary artery (LMCA) in 67% cases (19% within 2mm) and within 5mm of the left anterior descending coronary artery (LAD) in 87% (36% within 2mm). The anterior sinus was within 5mm of the LAD in 1% and out of 5mm from LMCA in all cases. Note that 93% LAS was within 5mm of the left aortic sinus of Valsalva (LASV) (within 2mm in 27%), remaining 80% right adjacent sinus (RAS) within 5mm from ascending aorta. The right coronary artery (RCA) was within 5mm of the RAS/right ventricular outflow tract in 82% cases. Both the left and RASs are intimately related to the aortic root. The LAS is more often close to LMCA, LAD, and the LASV. The anterior sinus is more frequently related to LAD than LMCA. This information may help heighten operator awareness of safety for increasingly performed complex procedures in this area.