Optimal visualization of heart vessels before percutaneous mitral annuloplasty

Abstract

Multi-slice computed tomography (MSCT) can be useful before percutaneous mitral annuloplasty (PMA) procedures to visualize the relations between the mitral valve (MV), left circumflex artery (LCx) and coronary sinus (CS). We performed a 64-slice MSCT in 196 patients (109 male; age 56.6 ± 11.4) with suspected coronary artery disease. A retrospective scan with ECG-gating was performed in each. In each case 3D VR and 2D MPR reconstructions were created. We used a subjective assessment of the quality of visualization to find the optimal phases of visualization for LCx, CS and both vessels together (relations). The quality of visualization were graded by 2 experts on 6-points scale. LCx was usually optimally visualized in the diastolic phases (70-80-90%) - 126/196 (64.3%). CS was usually optimally visualized in the systolic phases (30-40-50%) - 177/196 (90.3%). The optimal phase for parallel visualization of LCx/CS (to observe anatomical relations) was 70-80% - 140/196 (71.4%). Good quality visualization was obtained for both vessels: LCx: 3.6 ± 1.4/CS: 4.1 ± 1.1. Reconstructions of parallel visualization of LCx/CS for PMA procedures to observe the relations between those vessels should be considered during diastole. In addition, independent reconstructions should also be performed optimized for the LCx and the CS.