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

• DOI: 10.1111/jce.13685
• Publication Date: 2018-07-06T10:07:57Z
• Authors: Xiaonan Dong; Min Tang; Qi Sun; Shu Zhang
• Keywords: Adult; Male; Chest Pain; Middle Aged; Pulmonary Artery; Sinus of Valsalva; Coronary Angiography; Coronary Vessels; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Catheter Ablation; Humans; Female; Aged

AbstractBackgroundAblation 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.PurposeTo describe the anatomic relationships of PSV to its adjacent structures using computed tomographic coronary angiograms (CTCA).MethodsWe studied 145 patients (77 males, age 47 ± 18 years) 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.ResultsThe left adjacent sinus (LAS) was located within 5 mm of the left main coronary artery (LMCA) in 67% cases (19% within 2 mm) and within 5 mm of the left anterior descending coronary artery (LAD) in 87% (36% within 2 mm). The anterior sinus was within 5 mm of the LAD in 1% and out of 5 mm from LMCA in all cases. Note that 93% LAS was within 5 mm of the left aortic sinus of Valsalva (LASV) (within 2 mm in 27%), remaining 80% right adjacent sinus (RAS) within 5 mm from ascending aorta. The right coronary artery (RCA) was within 5 mm of the RAS/right ventricular outflow tract in 82% cases.ConclusionsBoth 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.