Abstract 4488: Advanced 3D Angiography and Quantitative Analysis on Coronary Arterial and Venous Structures for Percutaneous Based Mitral Annulus Repair
A novel technique of transvenous mitral annuloplasty has been introduced for reduction of mitral valve regurgitation. Such a procedure currently relies on two-dimensional (2D) X-ray based imaging as the sole or the major imaging modality for guidance and quantification of key parameters. Three-dimensional (3D) coronary venous and nearby arterial anatomy must be visualized and quantified for planning and performing intervention. We assessed the feasibility of patient-specific 3D vascular modeling and quantification using coronary angiography with both arterial and venous opacification. A pair of routine cine coronary angiograms containing the delayed venous phase was acquired based on a single-plane imaging system and during breath-holding. The 3D coronary arterial and venous trees consisting of the major and secondary vessels were created at the end-diastole (ED) and end-systole (ES). The geometrical evaluation of the venous system include length (L), diameter (D), radius of curvature (ROC), take-off angle (T-A) of side-branch, and a stereoscopic rendering to inspect the spatial relationship of major venous pathway from GCV to AIV (i.e., cross-over or parallel to each other) relative to its adjacent companion artery. Thirteen cases have been selected for 3D modeling and analyses. The average D at the CS is 8.22+/− 2.08 mm (ED) and 10.49 +/− 2.91 mm (ES). The average D, L, and ROC on the major venous pathway (from CS to AIV) are 4.96 +/− 1.18 mm (ED)/6.0 +/− 1.35 mm (ES), 112.24 +/− 19.43 mm, and 2.53 +/− 0.6 cm (ED)/2.41 +/−0.55 cm (ES). The average T-A of individual side-branches are 113.06 °+/− 33.35° (LMV), 59.86 ° +/− 17.21° (MCV), 124.07 ° +/− 23.01° (PV), and 46.55 ° +/− 23.43° (AIV). The venous pathway was under the major proximal branch of the left circumflex artery system in 5 cases and above 8 cases allowing an assessment of potential coronary artery compression with a venous based cinching device. The 3D anatomy, morphology variation, and spatial relationship of coronary artery and vein can be accurately assessed using angiographic data and validated 3D modeling method. This information can be used for patient selection, device sizing, and optimal placement of a coronary venous device for mitral annulus repair.