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Coronary computed tomography angiography (CTA) investigates not only coronary arteries but also coronary veins. The aim of this study was to clarify the anatomy of the crossing points and adjacent cardiac wall of coronary arteries and veins and to discuss the clinical relevance.
Methods and Results
Seventy-six coronary CTA images were retrospectively reviewed using the slab maximal intensity projection technique. Three vessel pairs were investigated: (i) the left circumflex artery (LCx)/coronary sinus (CS), (ii) the diagonal branch/anterior interventricular vein, and (iii) the atrioventricular node branch (#4AV)/posterior interventricular vein. Pattern A was defined when arteries ran between the vein and the muscle; pattern V was when the vein ran between the artery and the muscle. Pattern A was detected in 72%, 33%, and 93% of crossing points (i), (ii), and (iii), respectively. The A-V-A was the predominant pattern combination, accounting for 41% of the patients. The LCx/CS crossing point was adjacent to the anterior (58%), lateral (34%), or posterior (7%) wall, with distances between the LCx ostium and the crossing point of 24 ± 7.8, 39 ± 11, and 52 ± 20 mm, respectively.
The crossing point anatomy of coronary arteries and veins showed typical patterns with some variation. These data could be used in clinical settings to (a) prevent arterial spasm or occlusion by radiofrequency ablation within the CS, (b) prevent LCx occlusion by the intra-CS implant of the Carillon® Mitral Contour SystemTM, and (c) predict the difficulty of wiring during percutaneous coronary intervention at the crossing point.