Trans-Coronary-Venous Interventions

Abstract

Abstract-The coronary venous system is routinely targeted during electrophysiological measurements or cardiac resynchronization therapy. However, several novel interventional techniques require coronary venous catheterization and visualization as well as transvenous delivery of devices and/or therapeutic agents. Recent reports suggest the possibility of a transvenous approach for the interventional treatment of refractory angina and mitral valve regurgitation. In addition, the coronary venous system has been used as a route for the delivery of stem cells in patients with left ventricular dysfunction due to ischemic heart disease. We review the potential value of using a coronary venous approach in association with recent therapeutic developments in the interventional treatment of structural and ischemic heart disease. We will also discuss techniques related to coronary venous catheterization. (Circ Cardiovasc Intervent. 2008;1:134-142.)Key Words: catheterization Ⅲ catheters Ⅲ valves Ⅲ valvuloplasty Ⅲ veins M ore than a century ago, Pratt 1 first described the use of coronary veins to deliver arterial blood to ischemic myocardium. His experiments showed that the coronary veins could be used as conduits for oxygenated blood and could preserve myocardial viability in the absence of normal arterial perfusion. Early in the 20th century, Beck described a procedure to treat patients with severe angina. Coronary venous pressures were elevated by surgically narrowing the coronary sinus (CS) in association with a partial pericardectomy. [2][3][4] This procedure known as the Beck I procedure was later modified to include a vein graft from the descending aorta to the great cardiac vein and partial ligation of the CS. Thus, in the Beck II procedure, the coronary venous system was partially arterialized. Several patients reported relief from anginal symptoms. These elegant operations were performed many years before the first coronary artery bypass graft surgeries and without the aid of cardiopulmonary bypass equipment. However, with the introduction of coronary artery bypass surgery and because of the long-term complications resulting from permanent obstruction of venous drainage including CS thrombosis, late myocardial hemorrhage, venous engorgement, edema, and subsequent fibrosis, these techniques were abandoned in the mid-1970s.Because of the enormous progress in the treatment of ischemic heart disease in the second half of the 20th century, there is a growing population of patients with chronic heart disease, severely altered contractile function, refractory ischemia, and/or functional mitral regurgitation (MR) who are not good candidates for surgery.Recently, several techniques using coronary venous access have been developed for targeted delivery of pharmacological agents, mechanical devices, or stem cells.In this study, we review the anatomy of the coronary venous system and focus on its potential value for new therapeutic approaches in invasive cardiology. The use of the coronary venous system for routine electrophys...

Catheter Ablation of Idiopathic Epicardial Ventricular Arrhythmias Originating from the Vicinity of the Coronary Sinus System

“…Although previous case reports and series have demonstrated that the transvenous approach is feasible and effective, it is important to note that complications caused by thermal or mechanical injury such as venous thrombosis, rupture or perforation of coronary veins, and neighboring coronary arteries stenosis can occur . Consequently, it is advisable to perform coronary angiography prior to and after ablation, with careful examination of the relationship between the ideal ablation site and the vessels, to minimize complication occurrence.…”

Multidetector Computed Tomography Angiography Combined with Intravascular Ultrasound for the Evaluation of Coronary Veins for Percutaneous Mitral Annulus Repair Using Transcoronary Sinus Devices

“…However, perioperative mortality is high, reaching 20% in high‐risk patients . Compared with surgery, percutaneous mitral annulus repair using transcoronary sinus devices is associated with a lower perioperative mortality . This approach also reduces MR, and improves symptoms and survival .…”

“…[16][17][18] Compared with surgery, percutaneous mitral annulus repair using transcoronary sinus devices is associated with a lower perioperative mortality. [19][20][21] This approach also reduces MR, and improves symptoms and survival. 8,9 The transcoronary sinus device consists of three sections: a self-expanding distal anchor, a link "bridge" and a proximal self-expanding anchor.…”

An Anatomical Study of Triangle of Brocq & Mouchet in Human Cadaveric Heart & Its Clinical Relevance

“…These "no options" patients frequently have diffuse coronary disease without a discrete target for angioplasty or surgical bypass [9].…”