Variations and angulation of the coronary sinus tributaries: Implications for left ventricular pacing

Abstract

Background Variations of the coronary sinus tributaries might result in difficulties in left ventricle electrode insertion during cardiac resynchronizing therapy. Morphometric features of tributaries, especially angulation of the coronary sinus tributaries, are crucial for coronary sinus procedures. Methods This study was carried out on 200 formaldehyde‐fixed human hearts (22.0% females, mean age of 48.7 ± 15.6 years). Results The inferolateral aspect of the left ventricle was accessible from the coronary venous tree in 77.0% (in 35% from one, 29% from two, and 13.0% from three tributaries). The middle cardiac vein was present in all cases, with a diameter of 1.8 ± 0.5 mm, cannulation distance of 5.3 ± 3.2 mm, and angle of 82.0 ± 12.8°. The inferolateral vein of the left ventricle varied greatly in number: single in 63.5%, multiple in 30.5%. The ostium diameter for a single vein was 1.3 ± 0.5 mm, cannulation distance was 21.1 ± 9.8 mm, and the angle was 98.1 ± 13.5°. The left marginal vein was present in 39.5% with an ostium diameter of 0.9 ± 0.5 mm, cannulation distance of 46.0 ± 12.0 mm, and angle of 92.0 ± 13.4°. Finally, the oblique vein of the left atrium was present in 71.0% with a diameter of 1.3 ± 0.8 mm, cannulation distance of 27.2 ± 9.4 mm, and angle of 136.8 ± 16.6°. Conclusions This study shows the clinically relevant morphometric characteristic of coronary sinus tributaries. The middle cardiac vein is the most constant among coronary veins. However, it is usually not suitable for left ventricular pacing. The inferolateral vein of the left ventricle is highly variable in number, but its morphology makes it a suitable target for left ventricular lead placement.

Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue—Implications for Cardiac Resynchronization Therapy Leads

“…This limits the accessibility of the anterolateral, lateral and posterolateral LV regions. The averaged branch positions in our examination are largely in line with those in previous studies (41,47,48).…”

Anatomy of the left atrial ridge (coumadin ridge) and possible clinical implications for cardiovascular imaging and invasive procedures

“…The ridge is also in close relationship with the vein of Marshall or its ligament, that is present in 71.0% and 29.0% of cases, respectively . These structures are located on the epicardial part of the ridge at a distance of 3 mm away from its superior level . Ganglia and fibers of the autonomic nervous system are also known to travel near the epicardial aspect of the ridge.…”

Left Ventricular Summit—Concept, Anatomical Structure and Clinical Significance

“…A delineation by an arched line, with the radius of this arc being the distance from the left coronary bifurcation artery to the first prominent left coronary artery septal perforator, represents the most inferior boundary of this arc region (triangle base). Inside this triangular area, the anterior interventricular cardiac vein (that travels through the anterior part of the atrioventricular groove) becomes the great cardiac vein that is further heading to the posterior part of the atrioventricular groove [10][11][12][13][14]. Thus, the great cardiac vein/anterior interventricular cardiac vein bisects the LVS into two distinct areas: superior area (also named the inaccessible area for radiofrequency ablation because of the significant risk of coronary vasculature damage) and inferior area (the accessible area for radiofrequency ablation, where the interventions are relatively safe) (Figure 1A) [7].…”