Sinus Height Research Articles

Clinical, Radiographic, and Histologic Evaluation of Maxillary Sinus Lift Procedure Using a Highly Purified Xenogenic Graft (Laddec(®)).

ABSTRACTObjectivesThe aim of this study was to evaluate the clinical, radiographic and histologic results when a highly purified xenogenic bone (Laddec®) was used as grafting material in maxillary sinuses.Material and MethodsIn fifteen patients requiring unilateral maxillary sinus augmentation, the grafting procedure was performed with Laddec®. Forty-two implants were installed after a 6 month healing period. The height of the augmented sinus was measured radiographically immediately after augmentation and postoperatively up to 36 months. At the time of implant placement, a bone core was harvested in each patient for histological examination.ResultsThe cumulative implant survival rate was 97.6%. The original height was 3.65 (SD 0.7) mm and the augmented sinus height was 13.8 (SD 1.4) mm after the surgery. The reduced height of grafted xenogenic material (RDL) at the implant insertion was 0.83 (SD 0.38) mm, and at the final postoperative visit was 0.91 (SD 0.25) mm, showing no significant correlation with the follow-up periods by Spearman’s test (P = 0.118). In addition, no significant difference in the RDL was observed according to the site of implantation (P = 0.682). The mean implant marginal bone loss was 0.38 (SD 0.24) mm. Histological analysis showed the bone cores were composed of 64.72 (SD 3.44)% newly formed bone, 17.41 (SD 2.02)% connective tissue, 16.93 (SD 2.83)% residual graft particles, and 0.94 (SD 0.11)% inflammatory cells.ConclusionsAccording to our data, the highly purified xenogenic bone (Laddec®), used as graft material in the sinus lift procedure, may create adequate bone volume, and appropriate osseointegration of dental implants.

Frontal Sinus Morphometry in Relation to Surgically Relevant Landmarks in the United States Population

Knowledge of frontal sinus morphometry is important in bifrontal, pterional, orbitozygomatic, and supraorbital craniotomies. Inadvertent frontal sinus violation can lead to infection, cerebrospinal fluid fistula, and mucocele formation. In particular, knowledge of anatomy in relation to surgically relevant landmarks can help surgeons perform these procedures more precisely and safely. We performed a descriptive radiographic analysis to better understand variations in frontal sinus anatomy. Using 3-dimensional reconstructive software, we analyzed 162 normal cranial computerized tomographic angiograms (from 80 men and 82 women). A line between the supraorbital notches (SONs) was used as a horizontal reference line (HRL). We recorded the maximum sinus height and width from the HRL and midline, respectively. In addition, sinus width was measured in relation to the SON at 0, 1, and 2 cm above the HRL. The mean maximal sinus height from the HRL was 1.8 cm. The mean maximum sinus width was 2.6 cm (right and left) from midline and 0.46 cm (right) and 0.49 cm (left) from the SON. Less than 11% of sinuses were lateral to the SON at 2.0 cm above the HRL and <6% of sinuses were >1.5 cm lateral to the SON at 1.0 cm above the HRL. Planned surgical corridors >1.5 cm lateral to the SON and/or >3.0 cm above the HRL are most likely to avoid the frontal sinus based on our radiographic measurements of normal sinus anatomy. Careful radiographic study and appropriate planning for more medial and/or inferior corridors is suggested.

Space maintenance in autogenous fresh demineralized tooth blocks with platelet-rich plasma for maxillary sinus bone formation: a prospective study.

This prospective study evaluated the effectiveness of autogenous fresh demineralized tooth block (Auto-FDT block) with platelet-rich plasma (PRP) for maxillary sinus augmentation with simultaneous implant installation. Auto-FDT block with PRP was used in Group 1 (n = 15) and combined graft (allograft and xenograft) powder with PRP was used in Group 2 (n = 15). For up to 2 years after the final prosthesis was installed, clinical and radiographic examinations were performed to evaluate the amount of graft materials, residual alveolar height (RAH), sinus height (SH) after grafting, augmented graft height (AGH) and resorption height (RH). In ten cases, biopsies were harvested for histological and histomorphometric analyses. A total of 59 implants were placed in a severe atrophic posterior maxilla with less than 5 mm of RAH and sinus augmentation. None of the patients developed sinusitis or other complications, such as implant loss. The graft material extracted included one molar (or 2 premolars) in Group 1 and 1.8 cc in Group 2. The radiologic examination revealed the following average between-group difference SH (Group 1, 14.12 ± 1.63 mm vs Group 2, 16.51 ± 1.29 mm) and AGH (Group 1, 11.62 ± 2.22 mm vs Group 2, 13.65 ± 1.35 mm). However, sufficient SH and AGH were observed for the implants in the Auto-FDT block group. Two years after final prosthesis was installed, no between-group difference in the RH was observed (Group 1, 1.23 ± 0.73 mm vs Group 2, 1.77 ± 0.54 mm, P = 0.021). The histomorphometric analysis revealed no between-group difference in the new bone volume (Group 1, 23.13 ± 1.42 % vs Group 2, 24.18 ± 2.19 %, P = 0.548). The results showed that Auto-FDT block with PRP can be used in grafted sinuses for implants with only one extracted molar (or two premolars). Auto-FDT block with PRP promotes new bone formation that is comparable with combined grafts. Auto-FDT block with PRP is as an alternative to bone grafting and can be a predictable procedure for sinus augmentation.

Computed tomography based forensic gender determination by measuring the size and volume of the maxillary sinuses.

Purpose:Identification of human body or remains after death is a forensic procedure, which is difficult to perform and is mandatory by law and in compliance with social norms. Sexing the recovered human remains is an integral part of the identification process. Maxillary sinus can be used for gender determination as it remains intact even when the skull and other bones may be badly damaged in casualties where the body is incinerated. Computed tomography (CT) provides an excellent method for examining maxillary sinuses.Materials and Methods:CT images were used to measure the mediolateral, superoinferior, and anteroposterior dimensions and the volume of the maxillary sinuses in 30 patients (15 males and 15 females) to investigate whether these parameters could be used to determine the gender of an individual for forensic identification. The t-test for independent samples was used to compare these values in males and females and the data were subjected to discriminative analysis using SPSS software.Results:Our method was able to predict the gender with an accuracy of 80.0% in males and 86.7% in females, with an overall accuracy rate of 83.3%.Conclusion:The accuracy rate in this study was comparable, if not higher than many other methods that have been used to predict the gender of an individual from skeletal remains. The length, width, height, and volume of the maxillary sinuses together with other bones could be used for gender determination with a fair degree of accuracy when the whole skeleton is not available.

A study on maxillary sinus dimensions by computed tomography in population of Tamil Nadu

Background and aims: Maxillary sinuses are the largest of the paranasal sinuses known for variability in their dimensions. The maxillary sinus dimensions can be better ascertained in living by using computed tomography instead of plain radiography. This study was planned for highlighting the variations in the dimensions of the maxillary sinuses of population of Tamil Nadu region. The aims of the present study were to estimate dimensions of the maxillary sinuses on computed tomographic (CT) scan of the head of patients from Tamil Nadu and to compare the data gender wise and sidewise. Material and methods: Maximum width, height and depth of maxillary sinus of both sides were measured in CT - head images of 100 males and 100 females of 20-50 years of age in Tamil Nadu. Comparison of data between genders and sides by applying unpaired student “t” test was done. Results : The mean depth, height and width of both right and left maxillary sinuses were comparatively less in females than the males and the difference was found to be statistically significant (P< .0001). On comparison between the sides of maxillary sinuses, the depth and the height of maxillary sinus did not show any significant difference in the measurements (p >.05), whereas the width of the left side (23.96 mm) was higher than that of the right side (23.69) and the difference was found to be statistically significant (P<.05). The combined average maxillary sinus dimensions (in mm) for both genders in the study population of Tamil Nadu are as follows: Right side depth: 33.71 ± 1.00; Left side depth : 33.65 ± 1.22; Right side height: 34.66 ± 2.71; Left side height: 34.74 ± 2.48; Right side width: 23.69 ± 0.78 and Left side width: 23.96 ± 0.86. Conclusion: The dimensions of maxillary sinuses in males were found to be larger than those of females and this difference was statistically significant. The average width of the maxillary sinuses on the left side is significantly more than that of right sided sinuses. Computed tomography measurements of maxillary sinuses may be useful in gender determination.

Sexual dimorphism of maxillary sinus using cone beam computed tomography

The aim of this study was to evaluate the sexual dimorphism of maxillary sinus dimensions using the CBCT imaging modality. Thirty CBCT scans of bilateral maxillary sinuses (60 maxillary sinuses) were retrospectively selected and the height, width, and depth of the sinuses were measured. All data were subjected to descriptive and discriminative functional analysis with generation of multiple logistic regression model and ROC analysis.The overall values of the parameters were significantly greater in the males as compared to the females with the right height (90.0%) and the left height (83.3%) being the best predictors. This study proposes the importance of sexual dimorphism of maxillary sinus dimensions particularly the sinus height, when other methods used in the field of forensics seem to be indecisive. It suggests the use of CBCT in forensics thus obviating the complete dependence on the usage of conventional CT.

Sinus Floor Augmentation Using Straumann® BoneCeramic™ and Bio-Oss® in a Split Mouth Design and Later Placement of Implants: A 5-Year Report from a Longitudinal Study.

Straumann® BoneCeramic™ is a synthetic biphasic calcium phosphate (BCP) aimed for sinus floor augmentation. Long-term follow-up of implants placed in BCP after sinus augmentation is still missing. The primary aim of the study was to compare survival rates and marginal bone loss of Straumann SLActive implants placed in either BCP (test) or Bio-Oss® (DBB) (control) after sinus floor augmentation. The secondary aim was to calculate graft sinus height at different time points. Bilateral sinus floor augmentation was performed in a split mouth model. Eleven patients (mean age 67 years) received 100% BCP on one side and 100% DBB on the contralateral side. After 8 months of graft healing, 62 Straumann SLActive implants were placed. After 5 years of functional loading (6 years after augmentation) of implants, marginal bone levels and grafted sinus height were measured, and implant survival and success rates were calculated. After 5 years of loading, all prosthetic constructions were in function although two implants were lost in each grafting material. The overall implant survival rate was 93.5% (91.7% for BCP, 91.3% for DBB, and 100% for residual bone). The success rates were 83.3% and 91.3% for BCP and DBB, respectively. There was no statistically significant difference in mean marginal bone level after 5 years between BCP (1.4 ± 1.2 mm) and DBB (1.0 ± 0.7 mm). Graft height reduction (GHR) after 6 years was limited to 6.6% for BCP and 5.8% for DBB. In this limited RCT study, the choice of biomaterial used for sinus floor augmentation did not seem to have any impact on survival rates and marginal bone level of the placed implants after 5 years of functional loading and GHR was minimal.

Optimal Placement of Cerebral Oximeter Monitors to Avoid the Frontal Sinus as Determined by Computed Tomography.

To determine the optimal location to place cerebral oximeter optodes to avoid the frontal sinus, using the orbit of the skull as a landmark. Retrospective observational study. Academic hospital. Fifty adult patients with previously acquired computed tomography angiography scans of the head. The distance between the superior orbit of the skull and the most superior edge of the frontal sinus was measured using imaging software. The mean (SD) frontal sinus height was 16.4 (7.2) mm. There was a nonsignificant trend toward larger frontal sinus height in men compared with women (p = 0.12). Age, height, and body surface area did not correlate with frontal sinus height. Head circumference was positively correlated (r = 0.32; p = 0.03) to frontal sinus height, with a low level of predictability based on linear regression (R(2) = 0.10; p = 0.02). Placing cerebral oximeter optodes>3 cm from the superior rim of the orbit will avoid the frontal sinus in>98% of patients. Predicting the frontal sinus height based on common patient variables is difficult. Additional studies are required to evaluate the recommended height in pediatric populations and patients of various ethnic backgrounds. The clinical relevance of avoiding the frontal sinus also needs to be further elucidated.

Is There a Relationship Between Optic Canal, Foramen Rotundum, and Vidian Canal?

In this retrospective study, we investigated the relationship between paranasal sinus, optic canal, foramen rotundum, and vidian canal measurements. Computed tomographic (CT) images of 320 adult subjects and 640 sides (right and left) were used. Paranasal sinus dimensions, optic canal (OC), foramen rotundum (FR), vidian canal (VC), bilateral FR (FRFR), bilateral vidian canal (VCVC), VC-foramen rotundum (VCFR), and VC-optic canal (VCOC) distances were measured. Right VCFR (6.06 mm), and right and left VCOC values (20.34 and 20.31 mm) of the males were significantly higher than those of the females (5.50, 18.91, and 18.80 mm, respectively). Foramen rotundum, OC, and VC values were positively correlated with each other. There was also positive correlation between FR width and maxillary sinus height. Increase of OC width was related to increase in FR width and area, VCVC distance; and decrease in maxillary sinus width. There was positive correlation between FRFR, VCVC, VCFR, and VCOC distance values. There was negative correlation between VC width and area; VCVC, VCFR, and VCOC distance; and maxillary sinus, ethmoid sinus, and sphenoid sinus measurement values. As these sinuses pneumatized more, VC width and area values decreased. As a conclusion, the paranasal sinus, OC, VC, and FR values showed relationship with each other. Before performing craniofacial and/or skull base surgeries, CT view should be taken to evaluate the localization and the course and dimensions of the OC and vidian nerve. It should be kept in mind that in the presence of more pneumatized paranasal sinuses in CT views, VC dimensions decreased.

Sphenoid sinus types, dimensions and relationship with surrounding structures

The human sphenoid sinus is an extremely variable cavity and an important landmark in hypophyseal surgery. The aim of this study was to investigate the relationship between the sphenoid sinus type, size, extent of pneumatization and occurrence of protrusions of the adjacent neurovascular structures.A total of 51 randomly selected skulls (≥20 years of age, 33 male; 102 sinuses) were analyzed using cone beam computed tomography to estimate pneumatization extension beyond the body of the sphenoid (planum sphenoidale, pterygoid process, greater wings, clivus, dorsum sellae) and protrusions of the maxillary, mandibular, optic or pterygoid nerve or the internal carotid artery.Difference in pneumatization type between the left and the right-sided sinus was observed in 45% of the skulls. Conchal pneumatization was registered in 2%, presellar in 24%, sellar in 41% and postsellar in 33% of total sinuses. Presellar sinuses frequently pneumatized planum sphenoidale and sporadically other structures, and were characterized by sporadic optic nerve protrusions. Sellar and particularly postsellar sinuses were characterized by simultaneous pneumatization extensions and neurovascular protrusions. In the case of postsellar-type sinuses, the probability of these multiple interactions was not affected by their actual size, while it increased with the increasing sinus dimensions in the case of sellar-type sinuses. A more detailed analysis indicated that increasing sinus height, length or width increased the probability of interactions and pneumatization of particular surrounding structures.Data suggest that the sphenoid sinus pneumatization type and dimensions might be used to estimate the risks of iatrogenic injury during transsphenoidal surgical procedures.

3D Measurement of Maxillary Sinus Height for Multidisciplinary Benefit

3D Measurement of Maxillary Sinus Height for Multidisciplinary Benefit

Evaluation of maxillary sinus septal type and height in partially edentulous maxilla using spiral computed tomography

Background: The presence of anatomic variations within the maxillary sinus such as septa has been reported to increase the risk of sinus membrane perforation during sinus elevation procedure for implant placement. This study aimed to measure the septal heights and correlate it with different types of septa. Material and methods: Thirty patients (15 males and 15 females) with partially edentulous maxillae and mean age (35) years were enrolled in this study. Sixty sinuses scanned with Spiral multislice Computed Tompgraphy, septal height measured after evaluation of septal type whether it was primary or secondary. Results: The results showed that 72.5 % of the septa detected were primary and this is statistically significant when compared with the percentage of secondary type (27.5%). There was a statistically significant difference in the height of septa between the two types, and the primary septa were higher. There was no significant difference between septal type and sex. Conclusions: A sound knowledge of maxillary sinus anatomy and anatomic variations such as septa is essential to prevent complication during surgical interventions involving this region.

Evaluation of Maxillary Sinus Septal Type and Height in Partially Edentulous Maxilla Using Spiral Computed Tomography

Evaluation of Maxillary Sinus Septal Type and Height in Partially Edentulous Maxilla Using Spiral Computed Tomography

Relative area measurement of maxillary sinus by computed tomography

OBJECTIVE: To evaluate the relative area of the maxillary sinus in edentulous posterior maxilla with regard to linear area, bone septa and sinus pathologies. METHODS: A retrospective longitudinal study was conducted of tomographic exams in 60 individuals between 35 and 75 years of age, with the inclusion criteria being the uni- or bilateral edentulous posterior maxilla. Measurements were taken by the program in 101 maxillary sinuses. The horizontal and vertical measurements of each sinus were multiplied and resulted in a linear area in mm2. RESULTS: Of the 101 maxillary sinuses evaluated, 14 presented sinus pathologies (13.86%) and 22 (21.78%) with bone septa. The mean mesio distal distance was 38.4 mm (p ≤ 0.05), mean height 34. 5 mm (p ≤ 0.05) and mean linear area of 1335.88 mm² (p = 0.05). The Student's-t and analysis of variance (ANOVA) tests were applied for statistical analysis There were no statistically significant difference in the height and width of the edentulous maxillary sinuses between genders, but there was a variation in the linear area and the finding of the presence of bone septa and sinus pathologies. CONCLUSION: The conclusion of this study corroborates those of previous study about the need for imaging exams with the purpose of obtaining information about the dimensions of the maxillary sinus, as guidance with regard to the quantity of graft material, choice of donor region, and presence of septa. These data serve as guidance in the sinus lift technique and the presence of sinus pathologies, which involve treatment before bone graft surgeries.

A study of morphometric evaluation of the maxillary sinuses in normal subjects using computer tomography images

Objectives: The paranasal sinuses are complex anatomical structures with a significant inter-individual variation. The dimensions of maxillary sinuses are particularly significant when considering endoscopic sinus surgery . The aims of this study were to estimate different dimensions of the maxillary sinuses measured on head CT, and their relations to sex of the individuals. Materials and Methods: Cranial computerized tomographic images (CT) of 200 normal subjects between the age groups of 18 and 80 years were observed in this study. The height, width, and depth of the maxillary sinuses were measured with a Philips Brilliance 64 CT. The statistical analysis for sex and age comparison for all the parameters was done. Results: The mean width, height, and depth of maxillary sinus in male on both right and left side were 27.8, 28.2, 39.9, 39.6, and 40.0, 39.7 mm but in females were 26.6, 26.7, 36.8, 37.1, and 36.6, 37.4 mm. The discriminative analysis showed that the accuracy of maxillary sinus measurements i.e. the ability of the maxillary sinus size to identify gender was 55% in females and 69.5% in males. Conclusion: This study on CT dimensions of maxillary sinuses may be beneficial for the ENT surgeons when planning for endoscopic sinus surgery and to support gender determination.

Antral Balloon Sinus Elevation and Grafting Prior to Dental Implant Placement: Review of 34 Cases

The objective of this study was to assess the antral balloon technique for sinus elevation followed by bone graft and implant placement. A total of 34 patients with atrophic edentulous posterior maxillary ridges underwent antral balloon sinus elevation followed by bone grafting (autogenous bone retrieved from the chin mixed with platelet-rich plasma) and implant placement. The population consisted of 26 male and 8 female patients with a mean age of 42 years (range, 33 to 56 years). Successful sinus membrane balloon elevation was performed in all 34 patients, and 62 implants were placed. A membrane tear in one patient was managed intraoperatively by placement of a collagen membrane. Two implants failed within 6 months, and the survival rate of the other 60 implants was 100% after 3 years of follow-up. The mean inflated balloon volume was 1.96 mL and the mean elevated sinus height by balloon was 11.6 mm. An average bone gain of 7.5 mm (range, 5.2 to 10.5 mm) was observed. This case series demonstrates the feasibility of antral balloon sinus membrane elevation followed by bone augmentation and implant placement. This technique offers optimal assurance for membrane safety, and it is less invasive than the routine lateral window technique, safe, and associated with less postoperative bleeding and discomfort. This method is predictable, easy to learn, and associated with low complication rates. However, large comparative studies with other techniques are required.

Assessment of frontal sinus dimensions to determine sexual dimorphism among Indian adults

Background:Sex identification of unknown individuals is important in forensic sciences. At times when only skull remains are found and other means of identification fails, radiographs of frontal sinus can be used for identification. Frontal sinus morphology is unique to individual and can be used effectively in person identification; whereas its use in determining sexual dimorphism is limited.Aim:To determine sexual dimorphism among Indians by evaluating frontal sinus pattern using postero-anterior radiograph.Materials and Methods:The right and left areas, maximum height and width of frontal sinus were determined in 300 digital postero-anterior view radiographs obtained from 150 males and 150 females aged between 18-30 years. The measurements were carried out by transferring the image to Adobe® Photoshop® CS3 extended. Comparison of values were done using student's t-test and accuracy of sex determination was assessed through Logistic regression analysis.Results and Conclusions:One hundred and forty seven males and 142 females show presence of frontal sinus with seven individuals showing unilateral/bilateral absence of frontal sinuses. The mean values of the frontal sinus height, width and area are greater in males. Right frontal sinus is larger than the left sinus in both the sex. The mathematical model based on logistic regression analysis gives an average concordance index for sex determination of 64.6%. Thus, frontal sinus provides average accuracy in sex determination among Indian population. This may be due to its greater variation in morphology.

Sinus Augmentation With Platelet-Rich Fibrin in Combination With Bovine Bone Graft Versus Bovine Bone Graft in Combination With Collagen Membrane

The purpose of this study was to compare the efficacy between the use of bovine bone graft material and platelet-rich fibrin (PRF) mixture (test group) and bovine bone graft material and collagen membrane combination (control group) in 2-stage maxillary sinus augmentation. According to specific inclusion/exclusion criteria, patients treated between 2008 and 2012 were selected. Panoramic radiographs were used for radiologic assessments. To evaluate the relationship between sinus-graft height and each implant, the bone level (BL) was divided by implant length (IL). To evaluate the change in the height of grafted sinus, the grafted sinus floor above the lowest part of the original sinus height (GSH) was divided by the original sinus height (OSH). Samples taken during implant surgery were used for histologic and histomorphometric analyses. Twenty-five patients, 32 augmentation surgeries, and 66 one-stage implants were included in the study. No implant loss or complication was observed in either group. There were no statistical differences according to new bone formation (P = .61) and biomaterial remnant (P = .87). During the evaluation period, the test group showed statistically less change in the BL/IL ratio (P = .022). The difference of GSH/OSH ratio was found to be insignificant between groups (P = .093). It was observed that the grafted sinus covering the implant apex and sinus floor was above the original sinus height in both groups. It may be concluded from this study that both combinations can be successfully used for sinus augmentation. Further studies evaluating different graft materials and PRF combinations in the early phases of healing would be beneficial.

Maxillary Sinus Augmentation with Autologous and Heterologous Bone Graft: A Clinical and Radiographic Report of Immediate and Delayed Implant Placement.

The aim of this study was to evaluate cumulative survival rate of implants placed on augmented maxillary sinus using a mixture of autologous bone harvested from the maxillary tuberosity and bovine-derived HA and to assess the height of the grafted material through radiographic evaluation. Thirty-five patients were treated with maxillary sinus augmentation and 93 implant fixtures were installed. The height of the augmented sinus and the gain of bone volume were measured by Cone Beam CT Scan and intraoral radiographs immediately after augmentation and up to 48months subsequently. Changes in the height of the sinus graft material were calculated radiographically. The cumulative survival rate was 98.92% in all 93 implants. Additionally, normal healing process without any complication was observed in all patients. The original sinus height was a mean of 4.52mm (range 2.0-6.4mm) and the augmented sinus height was a mean of 14.1mm (range 12.0-16.5mm) after the surgery. The bone volume gain was a mean 9.613mm (range 7-13mm). Within the limitations of this study, it would appear from the clinical and radiographic results that the sinus lift procedure with autologous bone graft harvested from the maxillary tuberosity combined with deproteinized bovine bone allows for a predictable outcome regarding the amount of bone formation in sinus floor augmentation and the immediate placement of implants, when possible, is recommended.

Leaflet length and left main coronary artery occlusion following transcatheter aortic valve replacement

Coronary artery occlusion during transcatheter aortic valve replacement is a rare complication. However, it is a very severe and life-threatening event. Although there are some possible causes of this phenomenon, definite etiologies and predictors are unknown because of the small number. We describe one case of left main coronary artery occlusion immediately after deployment of a prosthetic valve. The patient became hypotensive and developed cardiopulmonary arrest. However, the coronary artery was successfully stented with a help of cardiopulmonary bypass and he recovered well. In this case, pre-procedural computed tomography (CT) showed the adequately high coronary height and no other significant conventional predictor for coronary occlusion. The examinations were retrospectively reviewed and the CT showed a long leaflet compared to the coronary sinus complex. The fluoroscopy appeared to show the long leaflet covering the left main coronary artery ostium immediately after the valve deployment. The height of the coronary artery ostium from the aortic annulus appeared sufficiently high in this case and did not explain the coronary compromise; leaflet length in relation to the coronary sinus dimension seemed more relevant. The ratio between leaflet length and curved coronary sinus height (L/C) may be one novel predictor for coronary artery occlusion.