Aortic valve structures as landmarks for the recognition of coronary artery ostia in the transthoracal echocardiography

Background: Occasionally, coronary arteries are recorded in transthoracal e chocardiography. The question was if this modality could be used as non-inv asive screening method of the coronaries. A prerequisite for this is an exa ct and reproducible measurement of the origin of the coronary arteries. Material and Method: The topography of the coronary Ostia in relation to th e aortic valve was examined morphometrically in the aortae Of 20 embalmed c adavers and 50 patients of a cardiologist's practice who underwent transtho racal echocardiography. Results: In all cases, the coronary arterial orifices were located eccentri cally in the coronary sinus, shifted to the noncoronary aortic sinus. The d istance between left coronary orifice to the commissure of the left and the right semilunar valvula was 13.3 mm on average in the anatomical measureme nts, whereas in the echocardiography this distance was 14.3 mm. The distanc e between the left ostium and the attachment of the left and the posterior semilunar valvula 9.4 mm, corresponding to 11.6 mm in echocardiography. The distance between right coronary orifice and the attachment of the right an d the left semilunar valvula was 18.0 and 17.3 mm respectively, and the dis tance between right coronary orifice and the commissure of the right and th e posterior semilunar valvula accounted for 8.5 and 9.7 mm respectively. On the average, the ostia were located 3.9 mm below-the level of the sinotubu lar junction. Multiple ostia occurred in 65%, 92% of these were in the righ t coronary aortic sinus, shifted from the main orifice to the attachment of the right and the left semilunar valvula. Conclusion: In the cardiologist's routine, the attachments of the aortic le aflets proved to be very useful as landmarks. The coronary arterial orifice s have been educible in nearly all cases. These results show that transthor acal echocardiography may be used in the screening for coronary artery dise ase.