Morphological study of coronary venous system in cardiac disorders.

Abstract

(Tori, 1952; Gensini et al., I965) while the pattern of regional venous drainage of the heart has also been studied by postmortem latex casts (Hood, I968). Hitherto, however, the involvement of the cardiac veins in heart diseases has not been reported. The present study concerns the morphological abnormalities, both gross and microscopical, in the cardiac venous system in some common heart diseases, as compared to the normal.Material and methods Seventy-six hearts were studied; 44 were diseased and 32 were normal controls. After removal from the body the hearts were injected via the coronary sinus with a mixture of barium sulphate and gelatin as used by Harrison and Wood (I949) for coronary arteries. After a few trials it was found that adequate filling of the venous system could be achieved by a brief initial injection pressure \cf 8o-ioo mmHg, lowered immediately and maintained at about 30 mmHg. Though injection through a single cannula into the coronary sinus Received I3 April I972. may be enough to fill the entire venous system, full visualization was more consistently achieved by using two cannulas, one in the coronary sinus and the other into the opening of the middle cardiac vein. After the injection a radiograph was taken in an ordinary anteroposterior position. Radiographs after opening and spreading the chambers were also taken initially but were not found to add any useful information. Subsequently, the hearts were inspected and the grossly visible veins identified by reference to the radiograph. Blocks for histology were taken from various sites, including the coronary sinus and major veins, and the mural venous channels of the ventricles and atria. Sections were stained by routine haematoxylin and eosin stain, and Weigert's elastic van Gieson. ObservationsThe 44 diseased hearts comprised I3 rheumatic, 9 with infarcts (healed and fresh), io hypertensive, and 8 chronic cor pulmonale, as well as 3 cachectic hearts with systemic malignancy and one with systemic scleroderma. Normal venograms and venous patternThe intramyocardial venules migrate to the epicardial surface between muscle bundles. Around the apex of the heart, both anteriorly and posteriorly, a plexus of grossly visible channels is formed. These resolve into major named channels as described below. The great cardiac vein starts anteriorly (or at times posteriorly and curves in front) and ascends in

Coronary Angiography with Diatrizoate and Metrizamide

“…This may improve diagnosis in cardiac disease (DATTA & GUPTA 1972). An increased quality of the phlebograms may be anticipated in angiography with metrizamide also in other vascular areas.…”