Morphometrical Description of the Left Ventricular Summit Vascular Triangle

Abstract

BackgroundPrecise anatomical description of coronary vascular topography in the epicardial area adjacent to left atrial appendage (LAA) is crucial for many procedures performed in this region. The aim of this study was to assess the mutual relations between branches of left coronary artery and great cardiac vein in the left ventricular summit region and to determine their neighborhood with the LAA.MethodsLeft coronary artery with its branches, great cardiac vein and selected cardiac structures were segmented from 200 contrast enhanced computed tomography scans and visualized using three dimensional semi‐automatic algorithms.ResultsIn 97.0% of cases the area between left coronary artery branches and great cardiac vein had triangular‐like shape, with area of 253.0±160.0mm2. The length of the left anterior descending and left circumflex coronary artery sections forming the triangle sides were 24.6±8.8mm and 20.8±6.5mm, respectively. The mean length of the triangle base formed by great cardiac vein was 26.2±11.3mm. On average, 78.8±25,3% of the triangle area was covered by LAA. In 30.5% the ramus intermedius coronary artery intersected the triangle. Within the triangle, the Dg1 was present in 53.0% of hearts, the Dg2 in 4.5%, Mg1 in 29.0% and Mg2 in 3.5%.ConclusionsThis study provided detailed morphometrical description of the left ventricular summit vascular triangle. The proximal parts of the left coronary artery branches are closely adjacent to LAA in most cases. Three‐dimensional visualizations of coronary vessels and LAA may lead to increased safety of invasive procedures performed in this region.