# Measurement of the Distance between the Mitral Annulus and the Left Circumflex Coronary Artery Using Multiplanar Reconstruction of Intraoperative Transoesophageal Echocardiography Images

## TL;DR

This study uses imaging to measure the distance between the mitral annulus and a coronary artery during heart surgery, finding shorter distances in patients with a specific heart condition.

## Contribution

The study introduces a less invasive method using multiplanar reconstruction of TEE images to assess anatomical distances related to mitral valve surgery.

## Key findings

- The left circumflex coronary artery is closest to the mitral annulus at 70-90 degrees counterclockwise from the anteroposterior axis.
- Patients with mitral annular disjunction had significantly shorter distances between the mitral annulus and the left circumflex coronary artery.
- MPR of TEE images is a useful tool for identifying patients with a short mitral annulus-left circumflex coronary artery distance.

## Abstract

We aimed to describe the anatomical distance between the mitral annulus and the left circumflex coronary artery (LCX) using multiplanar reconstruction (MPR) of transoesophageal echocardiography (TEE) images and to investigate its association with mitral annular disjunction (MAD).

A single-centre retrospective cohort study included 54 patients who underwent mitral valve repair for mitral regurgitation between January 2020 and July 2021. We measured the distance between the mitral annulus and the LCX (ML distance) using MPR of intraoperative TEE images. As an exploratory analysis, we compared the ML distance between patients with MAD (group D: N = 11) and those without (group N: N = 43).

The LCX was closest to the mitral annulus at 70-90 degrees counterclockwise from the anteroposterior axis. No cases of LCX injury were observed. MAD was most frequently observed at P1, and all patients in group D had disjunction at P1. The minimum ML distance was significantly shorter in group D than in group N (3.2 [1.1] mm in group D, and 4.9 [2.1] mm in group N). Overall, the ML distance was shorter in group D than in group N, and was significantly shorter at 70-100 degrees.

MPR of intraoperative TEE images is a less invasive and useful tool to detect patients with a short ML distance. The area of the closest distance from the mitral annulus to the LCX is near the anterolateral commissure, especially in patients with MAD.

One of the complications associated with mitral valve surgery is injury to the left circumflex coronary artery (LCX).