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

Abstract

Background: Ablation 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.

Purpose: To describe the anatomic relationships of PSV to its adjacent structures using computed tomographic coronary angiograms (CTCA).

Methods: We 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.

Results: The 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.

Conclusions: Both 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.

Keywords: anatomy; catheter ablation; complications; coronary artery; pulmonary sinus of Valsalva.