Anatomical Variants of Coronary Venous System on Cardiac Computed Tomography

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he variety of cardiac devices for transvenous implantation has increased in the years, mostly due to evidence of effectiveness of this therapy in chronic heart failure. Special attention is placed on cardiac resynchronization therapy (CRT) or combination of those devices with implanted cardioverter defibrillator. 1-5 During these procedures, the implantation of left ventricle lead is necessary. The only way for transvenous left ventricle lead implantation is coronary sinus (CS) cannulation from the right atrium, and finally implantation of the lead into one of the coronary veins. 6 Effectiveness and success of implantation have been shown to depend mainly on a proper placement of the left ventricle electrode into the coronary target vein. 7, 8 Lateral, posterolateral and anterolateral veins (PLV and ALV) provide optimal hemodynamic benefits. Meanwhile, most operators are faced with the problem of huge anatomical variability of coronary veins. Knowledge of the coronary venous system (CVS) anatomy is an important factor before many electrophysiological procedures, such as CRT or ablations. The CVS was the subject of a few research groups, but most of the research came from post mortem studies. 9,10 In a few studies, a huge anatomical variability of CVS was documented; however, its variants have only rarely been classified. 11 Recent data indicated a potential of the latest generation multislice computed tomography (MSCT) scanners for CVS anatomy visualization; 12,13 however, anatomical variants with emphasis on target veins for CRT have not been examined yet.The purpose of the present study was to evaluate anatomical variants of CVS in MSCT in the context of target veins for CRT. MethodsA total of 199 patients (114 males, 57.3%), aged 56.6±11.5 with suspected coronary artery disease (CAD) were included in the study. A suspicion of CAD was based on clinical symptoms such as chest pain, shortness of breath when exercising or during other vigorous activities and other typical/ atypical symptoms co-existing. Non-specific electrocardiogram (ECG) changes and positive results of exercise testing was also a basis for performing MSCT. Arterial hypertension and hyperlipidemia were the most prevalent CAD risk factors, present in 143 (71.8%) and 94 (47.2%) patients, respec- In a few studies, huge anatomical variability of coronary venous system (CVS) has been documented without analysis of its variants. The aim of the present study was to evaluate anatomical variants of CVS in multislice computed tomography (MSCT).

Gender-related differences in coronary venous anatomy: a potential basis for various response to cardiac resynchronisation therapy

“…In 2011 we described the anatomical variants of the coronary venous system [19]. In this research we confirmed a high degree of anatomical variability in the cardiac vein -this was also corroborated by Malagò et al [17] and Chan et al [15].…”

“…There are some imaging techniques that can visualise the anatomy of the coronary venous system in live subjects [15]. Multi-slice computed tomography (MSCT) appears to be the most accurate and is probably the most frequently used imaging technique for venous anatomy evaluation [16][17][18][19].…”

Assessment of the coronary venous system by using cardiac CT

“…There are several types of coronary venous system imaging, each of which has its own advantages and disadvantages (12,(20)(21)(22)(23). The conventional method used to evaluate coronary venous system is invasive retrograde cardiac venography.…”

Association between changes in coronary artery circulation and cardiac venous retention: a lesson from cardiac computed tomography

“…In all of the patients, the coronary venous system was analyzed including the number of visible coronary veins and the type of veins visualized (coronary sinus, anterior, antero-lateral, lateral, postero-lateral, posterior veins and middle cardiac veins). The nomenclature of those vessels was based on earlier published methodology [8]. …”