Left Marginal Vein Research Articles

Variations of coronary sinus tributaries among patients undergoing cardiac resynchronisation therapy.

In cardiac resynchronisation therapy (CRT), the coronary venous system is used for left ventricular pacing electrode placement. Despite the well- -known anatomy of the coronary sinus and its tributaries, heart failure patients' remodelled and enlarged left ventricles may impede the successful lead placement because of acquired anatomical obstacles. Fifty-five patients qualified for CRT treatment were divided into ischaemic and non-ischaemic cardiomyopathy. Forty-four control groups without heart failure underwent dual-source computed tomography (CT). Rendered reconstructions of cardiac coronary systems were compared. The presence of main tributaries was comparable in all groups. The left marginal vein, small cardiac vein, and oblique vein of the left atrium were present in 63%, 60%, and 51% of the hearts in all the groups. CRT referred CTs had significantly longer distances between posterior and lateral cardiac veins over the left ventricle (p < 0.05), wider angles of tributaries (p = 0.03), and smaller lumen of coronary sinus (p = 0.03). In the non-ischaemic group, the posterior interventricular and great cardiac veins are more extensive than in the control group. Age-related analysis of vessel size shows a moderate correlation between age and diminishing mean vessel size in all the groups studied. The general structure of the coronary heart system is consistent in patients with and without heart failure. The variance of the general structure, or the presence of adequate veins, is an individual variation. The use of CT and analysis of the coronary veins allow better planning of the CRT-D implantation procedure and may reduce the risk of ineffective left ventricular electrode implantation.

Morphological Study of Small Cardiac Vein, Right Marginal Vein, Posterior Vein of the Left Ventricle, Left Marginal Vein, Oblique Vein of Marshall, and Anterior Cardiac Veins in Human Hearts of Western Region of U.P – Clinical Implication

Introduction: Cardiac venous system is an important system for various cardiac interventional procedures such as cardiac catheterization. Various veins like right marginal vein, small cardiac vein (SCV), posterior vein of the left ventricle, left marginal vein, oblique vein of Marshall drain into coronary sinus. While anterior cardiac veins drain right ventricular wall directly into right atrium. Materials and Methods: An observational cross-sectional study was conducted on thirty cadaveric hearts during a 2-year period in Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Anatomy Department. The length, diameter of SCV, left marginal vein, posterior vein of the left ventricle, right marginal vein, and oblique vein of Marshall were taken. Results: The study reveals the length of SCV as 28.12 ± 22.87 mm. The length of right marginal vein and posterior vein of the left ventricle is having a significant correlation with age. The length of oblique vein of Marshall is lower in males as compared to females. A number of ACVs were significantly related to weight of cadaver in males. Conclusions: The present study provides data of cardiac veins for various cardiac interventional procedures.

Morphological and Morphometric Study of Coronary Sinus in Human Cadaveric Hearts in Gujarat Region, India: A Cross-sectional Study

Introduction: The major vein draining blood from the heart is the Coronary Sinus (CS). Its significance in facilitating numerous cardiac treatments such as biventricular pacing, and the placement of a variety of cardiac devices has made the CS a therapeutically essential structure. The development of advanced invasive and interventional cardiac procedures requires a thorough understanding of CS anatomy. Aim: To determine the location, shape, length, and width of the CS together with its left atrial muscular coverage in hearts of formalin-fixed cadavers. Materials and Methods: The present study was a cross- sectional study in which data was collected from 90 adult human cadaveric hearts preserved with formalin from both sexes. Forty cadaveric heart was obtained from Department of Anatomy, Pramukhswami Medical College, Karamsad and 50 from Dr. ND Desai Medical College and Hospital, Nadiad, Gujarat, India and study was conducted from August 2020 to July 2022. External Lengths (EL) of CS were measured using thread and Vernier Calliper at different levels (EL1-From the entry of oblique vein into CS and EL2-From the point of union of the great cardiac vein and left marginal vein upto its termination). CS width was measured: at the beginning, at the point where Middle Cardiac Vein (MCV) enters, and at the point where it terminates in the right atrium. CS walls were examined to see whether the muscles of the left atrium covered them or not. Using Statistical Package for the Social Sciences (SPSS) software, a descriptive analysis was conducted to determine the range, mean, and standard deviation. Results: In all 90 (100%) hearts, CS was found in the posterior atrioventricular sulcus. Tubular-shaped CS was found in 80 (88.9%) hearts, while 10 (11.1%) hearts had funnel-shaped CS. The EL1 of the CS was 43.75±4.68 mm and EL2 was 40.19±5.62 mm. The width of the CS was 6.71±1.47 mm at the beginning, 8.49±1.89 mm at the entrance point of MCV, the maximum width at termination in the right atrium was 8.14±2.16 mm and the minimum width was 5.16±1.70 mm. Muscles of the left atrium covered CS in all cases. Conclusion: The CS has a variable location, shape, length, and width despite being a constant component of the heart’s venous system. Its importance in giving access to various cardiac procedures has made it a clinically significant structure. The baseline data of this study can help the cardiologists performing various cardiac procedures in the Gujarat population.

Venous drainage of the heart of the red fox (Vulpes vulpes)

This study was carried out to reveal the coronary venous system of the red fox (Vulpes vulpes) heart. The hearts used in the study were obtained from six red foxes that were brought to the Kafkas University Wildlife Rescue and Rehabilitation Centre after serious injuries due to firearms or traffic accidents and could not be saved despite all interventions. Latex was injected from the cranial vena cava and caudal vena cava to expose the coronary vasculature. Hearts were photographed after dissection. It was determined that venous drainage of the red fox heart was provided by the great cardiac vein, middle cardiac vein, right cardiac veins, and the smallest cardiac veins. The strongest of these veins was determined to be the paraconal interventricular vein with a diameter of 3.03 ± 0.44 mm. It was determined that the paraconal interventricular vein was accompanied by a strong vein with a diameter of 2.09 ± 0.43 mm in five of six fox hearts examined. It was observed that left atrial oblique vein participated in the formation of the coronary sinus in four hearts, and the great cardiac vein, middle cardiac vein, and the left marginal ventricular vein were seen to be drained into the coronary sinus in the other two hearts. It was determined that the paraconal interventricular vein and middle cardiac vein collected the venous blood of septum interventriculare via septal veins in all hearts. In this study, the smallest cardiac veins were clearly identified for the first time, and the myocardial bridge was revealed in a wild animal for the first time.

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

Subvenous epicardial fat tissue (SEAT), which acts as an electrical insulation, and the venous diameter (VD) both constitute histomorphological challenges for optimal application and lead design in cardiac synchronization therapy (CRT). In this study, we characterized the morphology of human coronary veins to improve the technical design of future CRT systems and to optimize the application of CRT leads. We retrospectively analyzed data from cardiac computed tomography (CT) of 53 patients and did studies of 14 human hearts using the postmortem freeze section technique and micro CT. Morphometric parameters (tributary distances, offspring angles, luminal VD, and SEAT thickness) were assessed. The left posterior ventricular vein (VVSP) had a mean proximal VD of 4.0 ± 1.4 mm, the left marginal vein (VMS) of 3.2 ± 1.5 mm and the anterior interventricular vein (VIA) of 3.9 ± 1.3 mm. More distally (5 cm), VDs decreased to 2.4 ± 0.6 mm, 2.3 ± 0.7 mm, and 2.4 ± 0.6 mm, respectively. In their proximal portions (15 mm), veins possessed mean SEAT thicknesses of 3.2 ± 2.4 (VVSP), 3.4 ± 2.4 mm (VMS), and 4.2 ± 2.8 mm (VIA), respectively. More distally (20–70 mm), mean SEAT thicknesses decreased to alternating low levels of 1.3 ± 1.1 mm (VVSP), 1.7 ± 1.1 mm (VMS), and 4.3 ± 2.6 mm (VIA), respectively. In contrast to the VD, SEAT thicknesses alternated along the further distal vein course and did not display a continuous decrease. Besides the CRT responsiveness of different areas of the LV myocardium, SEAT is a relevant electrophysiological factor in CRT, potentially interfering with sensing and pacing. A sufficient VD is crucial for successful CRT lead placement. Measurements revealed a trend toward greater SEAT thickness for the VIA compared to VVSP and VMS, suggesting a superior signal-to-noise-ratio in VVSP and VMS.

Evaluation of the anatomical variations of the coronary venous system in patients with coronary artery calcification using 256-slice computed tomography.

The factors that determine the anatomical variations of the coronary venous system (CVS) are poorly understood. The objective of this study was to evaluate the anatomical variations of the CVS in patients with coronary artery calcification. 196 patients underwent non-contrast CT and coronary CT angiography using 256-slice CT. All subjects were divided into four groups based on their coronary artery calcium score (CACS): 50 patients with CACS = 0 Agatston unit (AU), 52 patients with CACS = 1–100 AU, 44 patients with CACS = 101–400 AU, and 50 patients with CACS > 400 AU. The presence of the following cardiac veins was evaluated: the coronary sinus (CS), great cardiac vein (GCV), posterior interventricular vein (PIV), posterior vein of the left ventricle (PVLV), left marginal vein (LMV), anterior interventricular vein (AIV), and small cardiac vein (SCV). Vessel diameters were also measured. We found that the CS, GCV, PIV, and AIV were visualized in all patients, whereas the PVLV and LMV were identified in a certain proportion of patients: 98% and 96% in the CACS = 0 AU group, 100% and 78.8% in the CACS = 1–100 AU group, 93.2% and 77.3% in the CACS = 101–400 AU group, and 98% and 78% in the CACS > 400 AU group, respectively. The LMV was less often identified in the last three groups than in the first group (p < 0.05). The frequency of having either one PVLV or LMV was higher in the last three groups than in the first group (p < 0.05). No significant differences in vessel diameters were observed between the groups. It was concluded that patients with coronary artery calcification were less likely to have the LMV, which might hamper the left ventricular lead implantation in cardiac resynchronization therapy.

Gross anatomy of coronary veins of the European bison (Bison bonasus)

BackgroundAlthough significant efforts have been put into restituting the European bison (Bison bonasus) and increasing its population, it remains a globally endangered species and requires conservation. Protection programs of bison indicate the need for morphological studies of their individual systems, in order to enhance restitution programs and enable appropriate veterinary care. The aim of this study was to investigate the morphology of the coronary veins of the European bison (Bison bonasus).ResultsThe study was carried out on 78 hearts of European bison of both sexes, aged 5 to 21 years. The subepicardial veins were clearly visible after being filled with dyed synthetic latex (LBS 3060), Plastogen G and Batson’s No. 17. In all the studied animals, the great cardiac vein drains into the coronary sinus. The interventricular paraconal branch and the circumflex branch of the great cardiac vein were distinguished. The left marginal vein, which originated in the apical area or halfway along the length of the left ventricular margin, was easily identified in 65 animals (83%). In most animals (51 bison, 65%), the middle cardiac vein drained into the coronary sinus, while in some animals it drained into the right atrium (27 animals, 35%).ConclusionsBlood from the cardiac walls is drained into the great cardiac vein, the middle cardiac vein, the right coronary veins and numerous small cardiac veins.

Assessment of the Relationship Between the Coronary Venous and Arterial Systems Using 256-Slice Computed Tomography.

To investigate the coronary venous system (CVS) and its spatial relationship with coronary arteries by using 256-slice computed tomography (CT). One hundred one patients underwent coronary CT angiography by using a 256-slice CT. In each patient, the CVS and its spatial relationship with coronary arteries were analyzed. We measured the diameters and angulations of the coronary sinus (CS), great cardiac vein, anterior interventricular vein (AIV), left marginal vein, posterior vein of the left ventricle (PVLV), and posterior interventricular vein (PIV), and the distances, respectively, from the CS ostium and from the crossing point to the ostium of corresponding tributaries. The following 5 pairs of veins and arteries had a higher frequency of intersecting compared with others: the CS/great cardiac vein and the left circumflex coronary artery (97.1%), the AIV and the diagonal or ramus branch (92.1%), the PIV and the posterior branch of left ventricle artery (88.1%), the left marginal vein and the circumflex or circumflex marginal (73.9%), and the PVLV and the circumflex or circumflex marginal (31.6%). The other 2 pairs had a higher frequency of running parallel to each other: the AIV and the left anterior descending artery (76.2%) and the PIV and the posterior descending artery (54.4%). Most tributaries were lateral to their corresponding arteries at the crossing point except for the AIV. For the PVLV and PIV, the distances from the crossing point to the ostium of corresponding veins when the veins were lateral to the arteries were smaller than those when the veins were medial to the arteries (P < 0.05). The CVS and its anatomical relationship with the coronary arterial system can be examined with details by using a 256-slice CT, which has important clinical implications.

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

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. This study was carried out on 200 formaldehyde-fixed human hearts (22.0% females, mean age of 48.7±15.6years). 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±0.5mm, cannulation distance of 5.3±3.2mm, 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±0.5mm, cannulation distance was 21.1±9.8mm, and the angle was 98.1±13.5°. The left marginal vein was present in 39.5% with an ostium diameter of 0.9±0.5mm, cannulation distance of 46.0±12.0mm, 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±0.8mm, cannulation distance of 27.2±9.4mm, and angle of 136.8±16.6°. 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.

Blood Vessels and Myocardial Thickness within the Left Atrial Appendage Isthmus Line.

Electric isolation of the left atrial appendage (LAA) and linear ablations in the area of the LAA base are gaining popularity. However, very little is known about the myocardial architecture and the presence of epicardial blood vessels within this region, which could significantly influence the course of such procedures. We examined 200 autopsied hearts (22.5% females, 46.7 ± 16.8 years old). The LAA isthmus (i.e., the line between the LAA ostium and the mitral annulus) was cut longitudinally. The myocardium was thickest at the LAA end of the isthmus (2.4 ± 0.7 mm) followed by its middle sector (2.1 ± 0.7 mm) inside the LAA, 5 mm from its ostium (1.9 ± 0.7 mm), and the mitral annulus end of the isthmus (1.8 ± 0.6 mm) (P < 0.0001). At least one artery was found in 96.5% of all samples (89.5% were single branched, 7% had two branches). The great cardiac vein was found in 77.0% and the left marginal vein in 2.5%. The artery was interposed between the endocardium and the great cardiac vein in 31.5% of cases. The smallest distance between the endocardium and the artery was 0.5 mm and between the endocardium and the vein was 0.7 mm. In total, we were able to distinguish fifteen different types of vascular arrangements within the LAA isthmus line in this study. The myocardium within the LAA isthmus is thickest at its LAA end. The left circumflex coronary artery branches are the most frequently-occurring vessels within the isthmus and are present in almost all cases, while the great cardiac vein is present in three quarters of hearts. Clin. Anat. 31:1024-1030, 2018. © 2018 Wiley Periodicals, Inc.

Association of Difference in Coronary Sinus Diameter by Computed Tomographic Angiography Between Patients in and Not in Stable Atherosclerotic Plaque(S).

BackgroundPathological finding fail to describe the morphology of coronary arterial plaques. Retrograde cardiac arteriography is a complicated procedure and does not detect all left posterior and marginal veins of the heart. Magnetic resonance angiography has long scan time and low spatial resolution. The objective of the present study was to assess the possible utility of the difference in coronary sinus diameter to quantify stable atherosclerotic plaque(s) using 256-slice coronary computed tomographic angiography.Material/MethodsA total of 336 patients were divided into 2 groups with 168 patients each. Patients who had heart failure were included in the study group and those who did not were included in the non-study group. Patients were subjected to cross-sectional study. Cardiovascular images were performed with 256-slice coronary computed tomographic angiography with a prospective electrocardiogram and clinical manifestation. Two-tailed paired t test following Dunnett’s multiple comparison tests was performed for the quantitative measurement of coronary computed tomographic angiography and clinical manifestation at 99% confidence level.ResultsThe clinical manifestation did not clearly show cardiac abnormality. The diameters of the superoinferior coronary sinus ostium was than that of the anteroposterior coronary sinus ostium, (p<0.0001, q=26.325). There was the difference in size of the coronary sinus ostium between patients in and not in heart failure (p<0.0001). The study group patients had longer coronary sinuses than patients in the non-study group (p<0.0001).Conclusions256-slice computed tomographic angiography is a feasible and is non-invasive bio-tool for evaluation of coronary artery anatomy.

Dimensions and Angulations of The Coronary Sinus Tributaries: Implications for Left Ventricular Pacing.

BackgroundThe coronary venous system is represented by the coronary sinus (CS) and its tributaries. High variability of the coronary venous tree challenges electrocardiologists. The aim of this study was to evaluate the morphology of CS tributaries, useful and important for invasive procedures, with regards to their angles of entrance to the CS, cannulation distance and ostium diameter.MethodsA total of 200 autopsied human hearts form healthy donors (22% females) were investigated. The ostia of coronary veins to the CS were identified and their diameters were measured. Distances between middle cardiac vein (MCV), posterior vein of left ventricle (PVLV) and left marginal vein (LMV) ostium and CS ostium (cannulation distance) and angles between coronary veins and CS long axis were evaluated. To simulate clinical procedures during measurements 8‐ and 7‐French catheters were used. This study has been conducted in conformance with the Basic Principles of the Declaration of Helsinki and their expansion.ResultsSmall cardiac vein was absent in 52 examined hearts (26.0%). The MCV was present in all assessed specimens. It's mean distance to CS ostium was 5.3±3.2 mm. All MCVs opened to CS, forming with its long axis mean angle of 82.0±12.8°. The average diameter of MCV ostium was 1.8±0.5 mm. The PVLV was observed in 127 hearts (63.5%), two PVLVs was detected in 54 specimens (27.0%) and three PVLVs in 2 hearts (1.0%). In 5 cases (2.5%) a single main PVLV and small ventricular tributaries were observed. The mean distance between CS ostium and the nearest PVLV (from the CS ostium) was 19.7±9.3 mm; second order vein: 27.5±10.4 mm; third order PVLV 31.3±0.1 mm. The mean diameters of PVLVs ostia were: first: 1.2±0.5 mm; second: 1.1±0.6 mm; third: 1.1±0.2 mm. The PVLV entered to the CS at mean angle of: first: 97.0±14.0°; second: 97.9±11.4° and third vein: 117.5±3.5°. The LMV was present in 94 hearts (47.0%). It was either a tributary of CS (17 specimens) or it entered to the GCV (62 hearts). In 15 cases small ventricular tributaries of LMV were detected (7.5%). The mean distance between CS ostium and LMV was 46.0±12.0 mm. It's mean angle was 92.0±13.4° and average LMV ostium diameter was 0.9±0.5 mm.ConclusionIn this research we found MCV with diameter never smaller than 0.5 mm, which makes it quite convenient for electrophysiological procedures. The PVLV was highly variable in number, unfortunately presence of more posterior veins makes it less suitable for cannulation due to smaller diameter. The LMV entering to CS would be potentially more accessible for lead implantation, but those were found only in 8.5% of hearts.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Additional Great cardiac vein

We report a case of a patient with an additional great cardiac vein, discovered during the implantation for car­diac resynchronization therapy (CRT). Anomalies of the coronary sinus and its tributaries may cause difficulties in appropriate implantation of the left ventricular lead but they can also be considered as alternatives for lead placement. Although unusual angiogram of the coronary venous system, a left ventricular pacing lead was successfully placed in the left marginal vein. To settle diagnostic doubts, multislice computed tomography was carried out.

Morphological characterization of the coronary sinus and its tributaries in short hair sheep. Comparative analysis with the veins in humans and pigs

To characterize morphologically the coronary sinus and its tributaries in short hair sheep, this descriptive cross-sectional study evaluated the coronary sinus and its tributaries in 62 hearts of short hair sheep. A semi-synthetic resin (Palatal GP40L 85%; styrene 15%) impregnated with mineral color blue was perfused through the coronary sinus. We evaluated the morphological characteristics and with a digital calibrator the biometrics of the coronary sinus and its tributaries. The length of the coronary sinus (± standard deviation) was 24.85 ± 4.94 mm. Proximal and distal calibers were 7.55 ± 1.54 mm, respectively. It was cylindrical in shape in 44 specimens (71%). The great cardiac vein originated at the apex in 44 hearts (71%), with the caliber of this vessel at the level of the paraconal interventricular sulcus being 2.55 ± 0.62 mm. The arteriovenous trigone was present in 50 specimens (80.6%) and presented a closed configuration at its lower and upper segments in 39 specimens (78%). The left marginal vein was present in 56 hearts (90.3%) and originated at the cardiac apex in 33 specimens (53.2%). The proximal and distal calibers of the middle cardiac vein were 1.74 ± 0.52 mm and 2.17 mm ± 0.71 mm respectively, and originated at the apex in 91.9% of the specimens. Due to the similitude of the features of the coronary sinus in short hair sheep with those of the human being, it is possible to propose this animal model for procedural and hemodynamic applied activities.

Absence of coronary sinus tributaries in ischemic cardiomyopathy: An insight from multidetector computed tomography cardiac venographic study

ObjectiveCardiac resynchronization therapy (CRT) is an important therapeutic strategy in heart failure. However, there is a high incidence of lead implantation failure and suboptimal response, particularly in ischemic cardiomyopathy. This failure rate may partly be secondary to lack of suitable coronary sinus branches for lead implantation. We sought to assess the presence of coronary sinus (CS) tributaries in patients with ischemic and non-ischemic cardiomyopathy. Materials and methodsMultidetector computed tomography (MDCT) was performed in 100 patients: 25 coronary artery bypass graft (CABG) patients with impaired left ventricular ejection fraction (LVEF), 25 CABG patients with preserved LVEF, 25 patients with non-ischemic cardiomyopathy, and 25 controls. The presence of the CS and its tributaries, including the posterior interventricular vein (PIV), posterolateral vein (PLV), left marginal vein (LMV), and the anterior interventricular vein (AIV) was assessed. ResultsThe CS, PIV, and AIV were demonstrated in all patients, whereas presence of a PLV and LMV was identified in 68% and 48% of CABG patients with impaired LVEF, 96% and 68% of CABG patients with preserved LVEF, 92% and 80% of patients with non-ischemic cardiomyopathy, and 100% and 80% of controls (p = 0.001 and 0.046 for PLV and LMV, respectively). ConclusionsThis is the first report to demonstrate that the posterolateral vein and left middle vein, branches of the coronary sinus, are detectable in a significantly smaller number of CABG patients with impaired LVEF compared to controls, CABG with preserved LVEF, and non-ischemic cardiomyopathy. The absence of CS tributary veins in ischemic cardiomyopathy potentially hinders proper lead implantation and results in suboptimal CRT response.

Left phrenic nerve anatomy relative to the coronary venous system: Implications for phrenic nerve stimulation during cardiac resynchronization therapy.

The objective of this study was to quantitatively characterize anatomy of the human phrenic nerve in relation to the coronary venous system, to reduce undesired phrenic nerve stimulation during left-sided lead implantations. We obtained CT scans while injecting contrast into coronary veins of 15 perfusion-fixed human heart-lung blocs. A radiopaque wire was glued to the phrenic nerve under CT, then we created three-dimensional models of anatomy and measured anatomical parameters. The left phrenic nerve typically coursed over the basal region of the anterior interventricular vein, mid region of left marginal veins, and apical region of inferior and middle cardiac veins. There was large variation associated with the average angle between nerve and veins. Average angle across all coronary sinus tributaries was fairly consistent (101.3°-111.1°). The phrenic nerve coursed closest to the middle cardiac vein and left marginal veins. The phrenic nerve overlapped a left marginal vein in >50% of specimens.

Alternative venous drainage of heart ventricles in rabbits

The objective of this study was to describe the uncommon connections between cardiac veins, alternative pathways within cardiac venous circulation and complex variability of the venous system in the heart ventricles. The study was carried out on 30 adult New Zealand White rabbits. The arrangement of the cardiac veins was studied by using the corrosion casts prepared with the Spofacryl® and by perfusion of coloured latex. The presence and organization of principal veins of the heart ventricles was relatively constant with a great variability in the mode of opening and forming a common trunk. The highest variations were observed in the region of the paraconal interventricular vein, the left and right marginal vein and the left distal ventricular vein. The left proximal ventricular vein was an inconstant tributary of the left circumflex vein and was seen in 17% of cases. The left distal ventricular vein was visible as one (13% of cases) or two veins (87% of cases). Angular vein was observed in 20% of cases. Numerous anastomosis were found among cardiac veins.

Assessment of the coronary venous system using 256-slice computed tomography.

PurposeTo investigate the coronary venous system and its relation to adjacent structures using 256-slice computed tomography (CT).Materials and MethodsThe study consisted of 102 patients who underwent coronary CT angiography (CTA) using 256-slice CT. For each patient, the coronary venous system and its relation to adjacent structures were evaluated. The appropriate locations and diameters of the posterior interventricular vein (PIV), posterior vein of the left ventricle (PVLV) and the left marginal vein (LMV) were detected. The paired student's t test was used to evaluate the difference between the diameter of the coronary sinus (CS) ostium in anteroposterior direction and that in superoinferior direction.ResultsThe CS, great cardiac vein (GCV), PIV, and anterior interventricular vein (AIV) were visualized in all cases. It was possible to evaluate at least one main vein with adequate caliber and regular course for cardiac resynchronization therapy (CRT) in 96.1% of these cases. The diameter of the CS ostium in superoinferior direction (11.7±2.1 mm) was larger than that in anteroposterior direction (9.0±2.0 mm) (t = 13.511, P<0.05). For the majority of the cases, the CS-GCV was located above the level of the mitral valve annulus (MVA), while the left circumflex coronary artery (LCX) was coursed between the CS-GCV and the MVA. LMV had more intersection with the circumflex or circumflex marginal than PVLV.Conclusion256-slice CT provides superior noninvasive evaluation of the coronary venous system which has important clinical implications.

The relative anatomy of the coronary arterial and venous systems: implications for coronary interventions.

An anatomical understanding of human coronary arterial and venous systems is necessary for device development and therapy applications that utilize these vessels. We investigated the unique use of contrast-CT scans from perfusion-fixed human hearts for three-dimensional visualization and analysis of anatomical features of the coronary systems. The coronary arterial and venous systems of eleven perfusion-fixed human hearts were modeled using contrast-CT and Mimics software. The coronary arteries that coursed near the major coronary veins, how close coronary arteries were to coronary veins, and the size of adjacent coronary arteries were recorded and analyzed. The majority of coronary veins were within 5 mm of a coronary artery somewhere along its length. Interventricular veins elicited the largest occurrence of overlaps. There was significant variability in the percentage of each vein that coursed within 0.5, 1, 2, and 5 mm of a nearby artery. The left marginal veins and anterior interventricular vein had the largest portion of the vein that coursed near a coronary artery. The right coronary artery most often coursed near the middle cardiac vein. The inferior veins of the left ventricle elicited the most variation in adjacent arteries. The left circumflex artery and/or branches of the circumflex artery coursed near the left marginal vein in all cases where there was an artery near the marginal vein. The wide variation of measurements reinforces the importance of a precise understanding of individualized cardiac anatomy in order to provide the highest quality care to cardiac patients.

Assessment of the coronary venous system by using cardiac CT

We aimed to investigate the coronary venous system and its variations by using dual source computed tomography (CT). Retrospective assessment was carried out on 339 patients who underwent coronary CT angiography using 128-slice dual source CT for suspected coronary artery disease. The examinations were performed according to routine imaging protocols used to evaluate coronary arteries. The coronary venous system was evaluated in each case using maximum intensity projection and volume rendering technique multiplanar reformation reconstructions. In each patient, the presence and calibration of normal anatomy, as well as the variations of the coronary sinus, middle cardiac vein, small cardiac vein, posterior cardiac vein, great cardiac vein, anterior interventricular vein, posterolateral vein, left marginal vein, and anterolateral vein were recorded. The coronary sinus, middle cardiac vein, great cardiac vein, and anterior interventricular vein were visualized in all of the patients. In all cases, one of the lateral or posterolateral veins of appropriate localization and diameter for cardiac resynchronization therapy was detected. The posterior cardiac vein was visualized in 87% of the cases, the left marginal vein in 87.9%, and the small cardiac vein in 20%. There was no significant difference in the diameters or visibilities of the coronary veins in terms of age. The coronary venous system and its tributaries may be examined in detail using CT angiography examination performed according to the routine coronary CT angiography protocol used for dual source CT. Dual source CT may be a valuable tool for evaluation of the coronary veins prior to invasive procedures that are directed at the coronary venous system.