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Advances in Arrhythmia and Electrophysiology

The Left Ventricular Ostium

An Anatomic Concept Relevant to Idiopathic Ventricular Arrhythmias

Takumi Yamada, MD; Silvio H. Litovsky, MD and G. Neal Kay, MD

From the Division of Cardiovascular Disease (T.Y., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham, Birmingham, Ala.

Correspondence to Takumi Yamada, MD, PhD, Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019. E-mail takumi-y@fb4.so-net.ne.jp

Received June 17, 2008; accepted September 4, 2008.

Key Words: left ventricular ostium • ventricular arrhythmia • aortic cusp • catheter ablation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Idiopathic ventricular arrhythmias (VAs) arising from the left ventricle (LV) are often accessible for catheter ablation from the aortic sinuses of Valsalva or adjacent to the mitral annulus (MA).¹ The aortic and mitral valves are direct apposition and attach to an elliptical opening at the base of the LV known as the LV ostium.² The VAs arising from this region are being increasingly recognized as targets for catheter ablation.^3–7 This review describes the anatomic features of the LV ostium and the electrocardiographic, electrophysiological, and angiographic characteristics that are relevant to the mapping and ablation of these arrhythmias.

	Anatomy of the LV Ostium

 
The dominant central structure of the heart is the junction of the aorta with the LV. Fundamental for understanding idiopathic VAs arising near the aortic and mitral valves are 2 concepts: first, these arrhythmias arise from the LV ostium (Figure 1); and second, the LV ostium is covered by the aorto-ventricular membrane, a tough fibrous structure which is perforated by the aorta anteriorly and the mitral valve (MV) posteriorly (Figure 2). The anatomic concept of the LV ostium and its covering, the aorto-ventricular membrane, are based on the pioneering work of McAlpine.²

View larger version (57K):   Figure 1. The left ventricular ostium (postero-cranial view). The left panel includes the aortic root with the right coronary sinus (R), left coronary sinus (L), and noncoronary sinus (N). In the right panel, the root of the aorta has been removed to demonstrate the elliptical ostium of the left ventricle (LV) with the junction of the right . . . [Full Text of this Article]