open access

Vol 76, No 2 (2017)
Original article
Submitted: 2016-07-19
Accepted: 2016-08-30
Published online: 2016-09-28
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Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

O. Beton1, H. Kaplanoglu2, B. Hekimoglu2, M. B. Yilmaz1
·
Pubmed: 27714730
·
Folia Morphol 2017;76(2):197-207.
Affiliations
  1. Department of Cardiology, Heart Centre, University Hospital, Cumhuriyet University, Sivas, Turkey, Türkiye
  2. Department of Radiology, Dıskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey, Türkiye

open access

Vol 76, No 2 (2017)
ORIGINAL ARTICLES
Submitted: 2016-07-19
Accepted: 2016-08-30
Published online: 2016-09-28

Abstract

Background: An understanding of the left main coronary artery (LMCA) anatomy is important for accurate diagnosis and therapy. We aimed to investigate LMCA anatomy via 128-multisliced coronary computed-tomography-angiography (CCTA) in patients with normal LMCA.

Materials and methods: A total of 201 CCTA studies were included in this study. Anatomical features of LMCA including cross-sectional areas of the LMCA ostial, LMCA distal, left anterior descending artery (LAD) ostial and left circumflex artery (LCX) ostial, and degree of tapering and LMCA bifurcation angles (BA) in the form of LMCA-LCX BA, LMCA-LAD BA, LAD-LCX BA at end-diastole and end-systole.

Results: The mean age was 55 ± 11; 55.7% of patients were males. Right coronary artery was dominant in 173 (86.1%) patients. Mean LMCA length was 10.0 ± 4.5 mm. The mean values of LMCA ostial, LMCA distal, LAD ostial and LCX ostial areas were 18.2 ± 5.1 mm2, 13.2 ± 4.0 mm2, 9.0 ± 3.2 mm2 and 7.6 ± ± 2.8 mm2, respectively. LMCA ostial-distal area, LMCA distal-LAD ostial area and LMCA distal-LCX ostial area ratios were ≥ 1.44 – < 1.69 in 47 (23.4%), 53 (26.4%), 47 (23.4%) patients, respectively, and were ≥ 1.69 – < 1.96 in 19 (9.5%), 24 (11.9%), 40 (19.9%) patients respectively. Systolic motion modifies LMCA BAs; systolic motion begets an increment of LMCA-LAD angle in 72.6% of patients and decrement of LAD-LCX angle in 75.6% of patients. Patients with T-shaped LAD-LCX BA was shown to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher diastolic-to-systolic range (DSR) of LAD-LCX BA compared to patients with Y-shaped LAD-LCX BA.

Conclusions: LMCA with T-shaped distal BA was found to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher DSR of distal BA compared to patients with Y-shaped distal BA. These findings may provide useful information for LMCA bifurcation stenting or designing dedicated stents for LMCA.

Abstract

Background: An understanding of the left main coronary artery (LMCA) anatomy is important for accurate diagnosis and therapy. We aimed to investigate LMCA anatomy via 128-multisliced coronary computed-tomography-angiography (CCTA) in patients with normal LMCA.

Materials and methods: A total of 201 CCTA studies were included in this study. Anatomical features of LMCA including cross-sectional areas of the LMCA ostial, LMCA distal, left anterior descending artery (LAD) ostial and left circumflex artery (LCX) ostial, and degree of tapering and LMCA bifurcation angles (BA) in the form of LMCA-LCX BA, LMCA-LAD BA, LAD-LCX BA at end-diastole and end-systole.

Results: The mean age was 55 ± 11; 55.7% of patients were males. Right coronary artery was dominant in 173 (86.1%) patients. Mean LMCA length was 10.0 ± 4.5 mm. The mean values of LMCA ostial, LMCA distal, LAD ostial and LCX ostial areas were 18.2 ± 5.1 mm2, 13.2 ± 4.0 mm2, 9.0 ± 3.2 mm2 and 7.6 ± ± 2.8 mm2, respectively. LMCA ostial-distal area, LMCA distal-LAD ostial area and LMCA distal-LCX ostial area ratios were ≥ 1.44 – < 1.69 in 47 (23.4%), 53 (26.4%), 47 (23.4%) patients, respectively, and were ≥ 1.69 – < 1.96 in 19 (9.5%), 24 (11.9%), 40 (19.9%) patients respectively. Systolic motion modifies LMCA BAs; systolic motion begets an increment of LMCA-LAD angle in 72.6% of patients and decrement of LAD-LCX angle in 75.6% of patients. Patients with T-shaped LAD-LCX BA was shown to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher diastolic-to-systolic range (DSR) of LAD-LCX BA compared to patients with Y-shaped LAD-LCX BA.

Conclusions: LMCA with T-shaped distal BA was found to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher DSR of distal BA compared to patients with Y-shaped distal BA. These findings may provide useful information for LMCA bifurcation stenting or designing dedicated stents for LMCA.

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Keywords

coronary computed tomography angiography, left main coronary artery, anatomic dimensions and bifurcations angles

About this article
Title

Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

Journal

Folia Morphologica

Issue

Vol 76, No 2 (2017)

Article type

Original article

Pages

197-207

Published online

2016-09-28

Page views

1418

Article views/downloads

1462

DOI

10.5603/FM.a2016.0059

Pubmed

27714730

Bibliographic record

Folia Morphol 2017;76(2):197-207.

Keywords

coronary computed tomography angiography
left main coronary artery
anatomic dimensions and bifurcations angles

Authors

O. Beton
H. Kaplanoglu
B. Hekimoglu
M. B. Yilmaz

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