二尖瓣峡部区域冠状动脉与静脉的毗邻研究

The adjacent relationship between coronary artery and vein in mitral valve isthmus

目的研究二尖瓣峡部(MI)区域解剖及冠状动、静脉毗邻关系。方法回顾性分析本院拟诊冠心病421例患者的256层冠状动脉计算机断层血管造影(CTA)检查的图像;测量MI心内膜侧的长度;观察并记录在MI区域心大静脉-冠状静脉窦(GCV-CS)、与之毗邻的冠状动脉;观察并记录MI区域GCV-CS及与之毗邻的左回旋支(LCX)的空间关系,并测量该区域内动静脉间的最近距离。结果MI的长度为[38.7±8.1(21.8~63.0)]mm;MI区域内动、静脉存在三种毗邻关系:LCX与GCV-CS毗邻关系占97.6%、右冠状动脉(RCA)与GCV-CS毗邻关系占1.7%、有GCV-CS无LCX或者RCA关系占0.7%;LCX与GCV-CS毗邻中存在4种空间关系:GCV-CS与LCX并列排在MI的心外膜侧占51.6%、LCX排列在MI与GCV-CS之间占19.0%、GCV-CS排列在MI与LCX之间占6.8%、GCV-CS排列在MI心外膜侧且LCX排列在同一切面上左室心外膜侧占22.6%;在LCX与GCV-CS的不同毗邻空间分布关系组中,LCX与GCV-CS的距离有显著性差异(P=0.00)。结论LCX和GCV-CS是在MI区域最常见的毗邻动、静脉;LCX与GCV-CS毗邻中存在4种空间关系;在LCX与GCV-CS的不同毗邻空间分布关系组中,LCX与GCV-CS的距离有显著性差异。

Objective To study the regional anatomy of the mitral valve isthmus(MI)and the relationship between coronary arteries and veins.Methods Four hundred and twenty-one suspected coronary heart disease patients in our hospital.256-slice spiral coronary computed tomography angiography examinations were performed.Measure the length of the endocardial side of the MI.Observed and recorded the great cardiac vein(GCV)or coronary sinus(CS)and adjacent coronary arteries in the MI.Observed and recorded the spatial relationship between the GCV or CS of the MI and the adjacent left circumflex coronary,and measured the distance between the GCV or CS and the left coronary circumflex branch.Results In the coronary computed tomography angiography images of 421 patients,the length of the MI was[38.7±8.1(21.8-63.0)]mm.There were three adjacent relationships between the arterial and the venous regions of the MI:the left circumflex coronary artery(LCX)and the GCV-CS adjoining 97.6%,right coronary artery(RCA)and GCV-CS adjoining 1.7%,GCV-CS without LCX or RCA accounted for 0.7%.LCX and GCV-CS were adjacent to arterial veins that were mainly adjacent in the MI area.There were four spatial relationships in the 411 adjacent LCX and GCV/CS relationships:GCV-CS and LCX in epicardial side of MI accounted for 51.6%,the LCX was located between the GCV/CS and the mitral valve isthmus accounting for 19.0%,GCV/CS was located between mitral isthmus and LCX accounting for 6.8%,GCV-CS arrayed on the epicardium side of MI and LCX arrayed on the same side of the left ventricle epicardium was 22.6%.In the different adjacent spatial distributions of the LCX and the GCV or CS,there was a significant difference in the distance between the LCX and the GCV-CS(P=0.00).Conclusions LCX and GCV-CS are adjacent to arterial veins that are mainly adjacent in the MI area.There are four spatial relationships in the adjacent LCX and GCV/CS relationships.In the different adjacent spatial distributions of the LCX and the GCV/CS,there was a significant difference in the distance between the LCX and the GCV-CS.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(2):154-157]