Posterior Vein Of Left Ventricle Research Articles

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.

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.

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.

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.

Evaluation of the Optimal Image Reconstruction Interval for Noninvasive Coronary 64-Slice Computed Tomography Venography

Objective: We investigated the appropriate reconstruction interval required to generate optimal quality images of the coronary veins and to evaluate the size of each vein at the systolic and diastolic phases using coronary computed tomography (CT) venography. Methods: Coronary CT venograms obtained from 30 patients using 64-slice CT were reconstructed at 0% to 90% of the cardiac cycle in 10% increments. Two radiologists assessed the image quality of the anterior interventricular vein (AIV), the great cardiac vein (GCV), the posterior vein of the left ventricle (PVLV), the posterior interventricular vein (PIV), the coronary sinus (CS) and the small cardiac vein (SCV). We determined the sizes of measurable CS (n = 16) and GCV (n = 12) at the end systolic and mid diastolic phases. Results: The most appropriate reconstruction point for all coronary veins turned out to be at the mid-diastolic phase. The size of the CS and GCV was greater at a 30% than that at a 70% R-R interval (p Conclusions: Image quality was optimal at the mid-diastolic phase for each coronary vein, but the sizes of the coronary veins varied during the cardiac cycle. The cardiac cycle must be considered when measuring the sizes of cardiac veins.

Usefulness of multidetector computed tomography coronary venous angiography examination before cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) is a treatment option for selected heart failure patients. In this study, the aim was to evaluate the usefulness of noninvasive cardiac vein imaging using multidetector computed tomography (MDCT) angiography before CRT. The MDCT scans of 34 patients (20 men; age range 47-65 years) with a history of cardiac failure were studied for CRT in two centers prospectively. The anatomy of the cardiac venous system, particularly the target veins [left marginal vein (LMV) and posterior vein of the left ventricle (PVLV)], was evaluated with noninvasive MDCT. The coronary sinus, anterior interventricular vein, and posterior interventricular vein were observed in all patients. The PVLV was present in 30 (88.2%) patients. The PVLV was chosen in 30 (88.2%) patients for CRT. If the PVLV had two or more branches, the widest branch was chosen for lead implantation. In four (11.7%) patients, the PVLV was absent and the LMV was chosen instead for lead implantation. In one patient (2.9%), partial thrombosis was detected in the coronary sinus with MDCT angiography. MDCT can be used to guide interventionalists for CRT by providing anatomical details of the cardiac venous system rapidly and noninvasively.

Non-invasive evaluation of the coronary venous system in patients with chronic systolic heart failure by 64-detector computed tomography

Imaging coronary venous systems to guide transcatheter cardiac interventions are becoming increasingly important, particularly in heart failure patients who are selected for cardiac resynchronization therapy (CRT). Failure of left ventricular (LV) lead placement during the procedure has been attributed to the inability to insert catheters into the coronary sinus and the lack of suitable side branches. To comparatively assess the value of a 64-detector MDCT examination in visualizing the cardiac veins and evaluating the morphological characteristics of the coronary venous system in patients with and without chronic systolic heart failure (SHF). A 64-detector MDCT examination of the heart was performed in 26 consecutive patients (five women, 21 men; mean age 57.80 ± 12.05 years; range 27-81 years) with chronic SHF. The morphological characteristics of the coronary venous system, such as the diameter, the distances between the venous tributaries, the angle and the tortuosity, were evaluated. The group was compared with a subgroup of 52 subjects without SHF (LV ejection fraction >40%) matched for age, sex, and the risk factors for coronary artery disease. The coronary sinus (CS), great cardiac vein (GCV), anterior interventricular vein (AIV), and posterior interventricular vein (PIV) were visualized in all 78 individuals. The posterior vein of the left ventricle (PVLV) (63/78), left marginal vein (LMV) (72/78), and the small cardiac vein (SCV) (50/78) were visualized in SHF and control patients (p = NS). The lengths between venous tributaries were higher (p > 0.05) and more dilated (P < 0.001 for CS, GCV, AIV, PVLV, LMV; p = 0.001 for PIV) in the cases with SHF compared with the control population. The angle between the CS-GCV axis and the venous branches was wider (p = 0.02 for LMV and PIV, p = 0.001 for PVLV) and did not have any correlation with the LV diameter in cases with SHF. There was no difference between the SHF and control groups in terms of the tortuosity of PVLV and LMV (p = NS). The study demonstrated an increase in the diameters, lengths, and angulations with the CS-GCV axis of the coronary veins in cases with SHF. A 64-detector MDCT is a feasible tool for non-invasive evaluation of the coronary venous system and may provide considerable information regarding numbers and morphology of coronary veins before percutaneous transcatheter cardiac therapy.

Contrast-enhanced whole-heart coronary MRA at 3.0T for the evaluation of cardiac venous anatomy

This study was designed to evaluate the value of contrast-enhanced whole-heart coronary MRA (CMRA) at 3.0T in depicting the cardiac venous anatomy. In cardiac resynchronization therapy (CRT), left ventricular (LV) pacing is achieved by positioning the LV lead in one of the tributaries of the coronary sinus (CS). Pre-implantation knowledge of the venous anatomy may help determine whether transvenous LV lead placement for CRT is feasible. Images of 51 subjects undergoing contrast-enhanced whole-heart CMRA at 3.0T were retrospectively analyzed. Data acquisition was performed using electrocardiography-triggered, navigator-gated, inversion-recovery prepared, segmented gradient-echo sequence. A 32-element cardiac coil was used for data acquisition. The visibility of the cardiac veins was graded visually using a 4-point scale (1: poor–4: excellent). The paired Student t test was used to evaluate differences in diameters of the ostium of the CS in anteroposterior and superoinferior direction. The cardiac veins were finally evaluated in 48 subjects with three anatomic variations. The diameter of the CS ostium in the superoinferior direction (1.13 ± 0.26 cm) was larger than in the anteroposterior direction (0.82 ± 0.19 cm) (P < 0.05). The mean visibility score of CS, posterior interventricular vein, posterior vein of the left ventricle, left marginal vein, and anterior interventricular vein was 4.0 ± 0.0, 3.4 ± 0.5, 3.4 ± 0.5, 3.0 ± 0.8, and 3.3 ± 0.5, respectively. In conclusion, contrast-enhanced whole-heart CMRA at 3.0T can depict the normal and variant cardiac venous anatomy.

Evaluation of cardiac venous anatomy with contrast-enhanced whole-heart coronary MR angiography at 3. 0 T

Objective To evaluate the value of contrast-enhanced whole-heart coronary magnetic resonance angiography ( CE CMRA ) at 3.0 T in the delineation of cardiac venous anatomy. Methods Contrast-enhanced whole-heart CMRA at 3.0T was performed in 43 consecutive subjects using ECG-triggered, navigator-gated, inversion-recovery prepared, segmented gradient-echo sequence with a 32-channel cardiac coil. The visibility of the coronary veins was graded visually using a 4-point scale.Continuous variable was expressed as (-x)±s. The paired student t test was used to evaluate the differences of the coronary sinus (CS) ostium diameter in anteroposterior and superoinferior directions. Results CMRA examination was successfully completed in 40 subjects with acquisition time of ( 6. 9 ± 1.8 ) min. The cardiac veins were finally evaluated in 38 of 40 (95.0%) subjects. The mean distance of the posterior vein of the left ventricle (PVLV) and the left marginal vein (LMV) to the CS ostium were (3.34 ± 0. 90) and (6. 12 ± 1.02) cm, respectively. The mean visibility scores of CS, posterior interventricular vein (PIV),PVLV, LMV, and anterior interventricular vein (AIV) were 4.0 ± 0.0, 3.4 ± 0. 5, 3.4 ± 0. 5, 3.0 ± 0. 8,and 3. 3 ± 0. 5, respectively. The diameter of the CS ostium in the superoinferior direction ( 1.13 ±0. 26) cm was larger than that in the anteroposterior direction (0. 82 ± 0. 19) cm (t = -4. 31 ,P <0. 05).Conclusion Contrast-enhanced whole-heart CMRA at 3.0 T can clearly depict the cardiac venous anatomy. Key words: Cardiac vessels; Magnetic resonance angiography; Anatomy,compartive

Simulation study of susceptibility gradients leading to focal myocardial signal loss

To assess the cause of a "bite"-shaped signal void artifact often seen in 1.5 Tesla (T) and 3T gradient echo MR images in myocardium along the infero-apical border of the heart, MRI simulation was used to conduct experiments impossible in reality. Two previous studies attempting to explain the origin of this artifact came to different conclusions. One suggested deoxygenated blood in the posterior vein of the left ventricle (PVLV) leads to a susceptibility gradient that causes the artifact. The other suggested the difference in susceptibility between lung tissue and myocardium was responsible. This study assessed the relative effect of each possible cause. Anthropometric phantoms were developed for use with a previously reported MRI simulator. The images were simulated at 3T with gradient echo scans using TE = 4 ms, TR = 25 ms, and theta = 25 degrees . The simulations indicate that both susceptibility differences can lead to signal losses in the area of the artifact with contributions from the PVLV being more localized while lung tissue effects are stronger but more spatially distributed. The data support the conclusion that both differences together, rather than one or the other, are responsible for the artifact.

Noninvasive coronary venous system imaging using 64-slice CT angiography

Objective To evaluate the 64-slice CT angiography in characterizing the coronary venous anatomy and the arterio-venous relationship.Methods Sixty-four slice CT coronary veins angiography images of 300 patients(187 men and 113 women,)were analyzed.The visibility of the coronary veins and arterio-venous spatial relationship were assessed qualitatively on two-and three-dimensional displays.The diameter of the coronary sinus ostium(CSO),middle cardiac vein ostium(MCVO)and posterior vein of left ventricle ostium(PVLVO)were measured.All data was statistically processed with SPSS for Windows.Results The CS,great cardiac vein(GCV)and MCV could be clearly visualized in all of the images.1-3 branches of PVLV could be observed in 273 patients(91.0%).Small cardiac vein(SCV)and Marshall vein were found in 56(18.7%)and 24(8.0%)cases respectively.Three patients had permanent vena cava superior on the left and one patient had a CS diverticulum.Posterior descending artery(PDA)was concomitant with MCV in 189 cases(63.0%)and intersected with MCV in 96 cases(32.0%).Left circumflex artery(LCX)was concomitant with CS in 122 cases(40.7%),intersected with MCV in 15 cases(5.0%),and intersected with PVLV in 104 cases(34.7%).There were no significant differences in age,sex and CHD groups among CSO,MCV,PVLV value.The supero-inferior diameter of CSO had a significant difference between male and female(F=6.67,P＜0.05).Conclusion Sixty-four slice CT venous angiography is able to be used for guiding electrophysiological procedures,which is especially useful due to the considerable variations in venous anatomy. Key words: Coronary vessels; Tomography,X-ray computed; Anatomy

Visualization of the Cardiac Venous System Using Cardiac Magnetic Resonance

We sought to investigate the value of cardiac magnetic resonance to depict cardiac venous anatomy. For cardiac resynchronization therapy the lead for the left ventricle is usually placed by transvenous approach into a tributary of the coronary sinus (CS). Knowledge of the anatomy and variations of the cardiac venous system may facilitate the positioning of the left ventricle lead. The cardiac magnetic resonance examinations of 23 subjects (16 volunteers and 7 patients) were retrospectively analyzed. All examinations were performed using navigator-gated whole-heart steady-state free precession coronary artery imaging after administration of intravascular contrast agents (gadofosveset in volunteers; Gadomer-17 in patients). The cardiac venous system was visualized in all subjects. The most frequent anatomical variant observed (in 12 subjects [52%]) was a connection of the small cardiac vein to the CS at the crux cordis. In 10 subjects (44%) the small veins entered the right atrium independently from the CS, and the posterior interventricular vein was connected to the CS at the crux cordis. Only one subject had a disconnection between the CS and posterior interventricular vein, which entered into the right atrium independently. The mean distance of the posterior vein of the left ventricle and the left marginal vein to the ostium of the CS was 15.2+/-4.7 mm and 49.7+/-14.1 mm, respectively. In conclusion, the anatomy of the cardiac venous system and its anatomical variability can be described using cardiac magnetic resonance. Its preimplantation visualization may help to facilitate the implant procedure and to reduce fluoroscopy time.

Detection of Phrenic Nerves and Their Relation to Cardiac Anatomy Using 64-Slice Multidetector Computed Tomography

The improved temporal and spatial resolution allowed by multidetector computed tomography (MDCT) has facilitated the noninvasive assessment of cardiac anatomy before transcatheter electrophysiologic procedures. Clarification of spatial relations of phrenic nerves and key cardiac structures is important to decrease potential complications. The purpose of this study was to reconstruct the course of the right and left phrenic pericardiophrenic bundles and their relations to cardiac structures using 64-slice MDCT. One hundred six consecutive subjects (age 61 +/- 13 years; 39% women) who underwent self-referred coronary computed tomographic angiography using 64-slice MDCT underwent retrospective assessment of the phrenic nerves contained within the pericardiophrenic bundles. The course of the nerves was outlined in relation to the left atrial appendage, coronary sinus, and cardiac veins. The ability to individually detect the left and right phrenic nerves, as well as the frequency of direct contact between the left phrenic nerve and cardiac veins, was recorded. The left phrenic nerve was identified in 78 of 106 patients (74%). It crossed the left atrial appendage (n = 72, 91%), great cardiac vein (n = 63, 80%), posterior vein of the left ventricle (n = 39, 49%), posterior interventricular vein (n = 8, 10%), and anterior interventricular vein (n = 7, 9%). Mean Hounsfield units (HUs) of the left phrenic nerve was 81 +/- 25. The right phrenic nerve was identified in 50 of 106 patients (47%). Mean HUs of the right phrenic nerve were 94 +/- 26. In conclusion, cardiac imaging using 64-slice MDCT enabled adequate detection of the left and right phrenic nerves in relation to cardiac anatomy. In the setting of electrophysiologic interventions, MDCT before a procedure may elucidate anatomic relationships and help minimize inadvertent complications.

Prospective evaluation of the anatomy of the coronary venous system using multidetector row computed tomography

Background Multidetector row computed tomography (MDCT) is a developing technique mainly used to evaluate the coronary arteries, but less attention has been paid to the coronary venous system. However, with the dramatic technological advancement of percutaneous therapies for heart failure or mitral insufficiency, a better knowledge about the anatomy of the coronary venous system may be of great utility. We sought the efficacy of MDCT imaging to delineate the coronary venous system. Methods 16 row MDCT scans were performed in 50 consecutive patients (42 men, age 61 ± 15 years, all in sinus rhythm). The inter-individual variability in terms of diameter, distance, angle of the main tributaries of the coronary venous system was reported. Results The coronary venous system was always visualized. A remnant Thebesian valve was observed in 18 patients, the diameter of the coronary sinus ostium was found 12.2 ± 3.6 mm and 15.3 ± 3.7 mm respectively in the antero-posterior and supero-inferior directions, the distance between the posterior vein of the left ventricle (PVLV) and the anterior interventricular vein (AIV) was found 108.6 ± 15.2 mm with a significant correlation with the mitral annulus diameter ( p < .002) and the left ventricular diameter ( p < 0.01). The left marginal vein (LMV) was more often tortuous when the angle between the LMV and the great cardiac vein was less than 60° ( p < 0.01). Conclusion 16 row MDCT imaging can be used to investigate non-invasively the coronary venous anatomy and may serve as a useful tool before percutaneous therapies involving the coronary veins.

Non-Invasive Visualization of the Cardiac Venous System in Coronary Artery Disease Patients Using 64-Slice Computed Tomography

This study was designed to evaluate the value of 64-slice computed tomography (CT) to visualize the cardiac veins and evaluate the relation between variations in venous anatomy and history of infarction. Cardiac resynchronization therapy (CRT) is an attractive treatment for selected heart failure patients. Knowledge of venous anatomy may help in identifying candidates for successful left ventricular lead implantation. The 64-slice CT of 100 individuals (age 61 +/- 11 years, 68% men) was studied. Subjects were divided into 3 groups: 28 control patients, 38 patients with significant coronary artery disease (CAD), and 34 patients with a history of infarction. Presence of the following coronary sinus (CS) tributaries was evaluated: posterior interventricular vein (PIV), posterior vein of the left ventricle, and left marginal vein (LMV). Vessel diameters were also measured. Coronary sinus and PIV were identified in all individuals. Posterior vein of the left ventricle was observed in 96% of control patients, 84% of CAD patients, and 82% of infarction patients. In patients with a history of infarction, a LMV was significantly less observed as compared with control patients and CAD patients (27% vs. 71% and 61%, respectively, p < 0.001). None of the patients with lateral infarction and only 22% of patients with anterior infarction had a LMV. Regarding quantitative data, no significant differences were observed between the groups. Non-invasive evaluation of cardiac veins with 64-slice CT is feasible. There is considerable variation in venous anatomy. Patients with a history of infarction were less likely to have a LMV, which may hamper optimal left ventricular lead positioning in CRT implantation.

Noninvasive visualization of the cardiac venous system using multislice computed tomography

We sought to evaluate the value of multislice computed tomography (MSCT) to depict the cardiac venous anatomy. During cardiac resynchronisation therapy (CRT), left ventricular (LV) pacing is established by a pacemaker lead in a tributary of the coronary sinus (CS). Knowledge of the CS anatomy and variations may facilitate the implantation of LV leads. The MSCT scans of 38 patients (34 men; age 60 +/- 12 years) were studied. Anatomical variants were divided in three groups, dependent on the continuity of the cardiac venous system at the crux cordis. The CS ostium and distances between the main tributaries were measured. The most frequently observed variant had a separate insertion of the CS and the small cardiac vein in the right atrium (24 patients [63%]). In 11 patients (29%), there was continuity of the anterior and posterior venous system at the crux cordis. In three patients (8%), the posterior interventricular vein (PIV) did not connect to the CS. The mean distance from the PIV to the posterior vein of the left ventricle (PVLV) was 42.4 +/- 18.1 mm, from the PVLV to the left marginal vein (LMV) 39.9 +/- 15.6 mm, and from the LMV to the anterior interventricular vein 45.4 +/- 15.3 mm. The diameter of the CS ostium was 12.6 +/- 3.6 mm in anteroposterior and 15.5 +/- 4.5 mm in the superoinferior direction (p < 0.01). The anatomy of the CS and its tributaries can be evaluated using MSCT. As substantial variation in anatomy was observed, pre-implantation knowledge of the venous anatomy may help to decide whether transvenous LV lead placement for CRT is feasible.

Aortovenous bypass graft to the posterior left ventricle in absence of an identifiable coronary artery

We report the case of a 70-year-old woman with significant intermediate coronary artery stenosis who underwent a series of stent procedures, ultimately leading to compromise of the origin of the circumflex artery. Intraoperatively, identification of an obtuse marginal coronary artery was impossible due to a thick layer of epicardial fat, calcification of the posterior atrioventricular groove, and an adherent, thickened pericardium. Therefore, a saphenous vein graft to the posterior vein of the left ventricle was constructed with ligation of the vein cephalad. This uncommon approach to surgical revascularization effectively relieved the patient's angina and may be of use in other difficult cases.

The venous drainage of the human myocardium.

New cardiological techniques such as coronary sinus catheterization and selective catheterization of the cardiac veins permit the opening of new experimental and clinical fields, for instance in venous angiography and the reverse nourishment of myocardium which is endangered by ischemia,and also in the electrophysiological study of the components of the conduction system. New approaches in heart surgery, such as the removal of accessory pathways of the conduction system (as in WPW syndrome), necessitate the realization of the topographical relationships of the vessels in the various sections of the coronary sulci in a different way. The objective of this work is, therefore, to present comprehensive and almost new macro- and microanatomical data about the venous drainage of the myocardium via the coronary sinus and its related and unrelated (non-coronary) cardiac veins. Examination of meticulously dissected heart specimens (of individuals who had achieved old or extreme old age at the time of their death in Germany: n=250) as well as corrosion casts of adult cardiac vessels (of individuals of all ages, n=25) formed the basis for the exact description and documentation of the occurrence, frequency, origin, and courses of both the normal and anomalously developed human coronary sinus and cardiac veins. A wide range of morphological and experimental references was consulted in order to enable thorough discussion of the anatomical findings in the light of modern cardiological diagnostics and treatment. The anatomical and clinical nomenclature is presented and there is a brief comment on modern diagnostic techniques and their applications where the cardiac veins are concerned. The two principal and one compound cardiac venous system are defined and discussed with reference to the existence of both the normal and anomalous coronary sinus and cardiac vein. 1. The greater (major) cardiac venous system (2) The smaller (minor) cardiac venous system (3)The compound cardiac venous system. The microanatomy of the various proper cardiac veins is not very well explained and illustrated in old or new literature; therefore, special attention is paid in the present study to the detailed microanatomy of the cardiac venous drainage. This includes the topograpy and structural and surface anatomy of the coronary sinus (position, length and shape, diameters, area of cross-section, circumference and volume, curvature, elevation, ostial angle, enlargement, duplication, absence), and the exact enternal and internal morphological landmarks of the coronary sinus with reference to its myocardial cover, isolated myocardial belts, and "free" myocardial cords which connect the atrial and ventricular myocardium, and the atrial ostium of the coronary sinus. It is established that the frequency, distribution pattern, courses and mode of opening of the major ventricular and atrial cardiac veins and the occurrence, morphology, and efficiency of the ostial valves of the coronary sinus and its tributaries all influence the success of any selective catheter implantation and venous reperfusion technique to a great degree. There are many peculiarities of the cardiac veins which are worthy of consideration, for instance intramyocardial and aberrant courses of the anterior interventricular vein, the oblique vein of the left atrium, the posterior interventricular vein, the small cardiac vein, the posterior vein of the left ventricle, the left and right marginal veins, and the anterior cardiac veins. Various forms and courses of the intramural venous tunnel, sinus or channel of the right atrium were found and illustrated, and discussed in terms of developmental and comparative anatomy. This review incorporates a great variety of clinically significant, new morphological findings with regard to the coronary sinus and the cardiac venous system. The many anatomical peculiarities and hindrances to the catheterization of the coronary sinus and the reperfusion of (even selected) cardiac veins are documented and evaluated; the various problems which may arise in venous reperfusion due to the presence of anatomical anomalies of the coronary sinus, cardiac veins, and ostial valves (of greater or lesser efficiency) are addressed. The presentation narrows a gap in the rather incomplete knowledge of the venous drainage of the human myocardium.

In vivo measurement of T*2 and field inhomogeneity maps in the human heart at 1.5 T.

Cardiac echo-planar imaging suffers invariably from regions of severe distortion and T*2 decay in the myocardium. The purpose of this work was to perform local measurements of T*2 and field inhomogeneities in the myocardium and to identify the sources of focal signal loss and distortion. Field inhomogeneity maps and T*2 were measured in five normal volunteers in short-axis slices spanning from base to apex. It was found that T*2 ranged from 26 ms (SD = 7 ms, n = 5) to 41 ms (SD = 11 ms, n = 5) over most of the heart, and peak-to-peak field inhomogeneity differences were 71 Hz (SD = 14 Hz, n = 5). In all hearts, regions of severe signal loss were consistently adjacent to the posterior vein of the left ventricle; T*2 in these regions was 12 ms (SD = 2 ms, n = 5), and the difference in resonance frequency with the surrounding myocardium was 70-100 Hz. These effects may be caused by increased magnetic susceptibility from deoxygenated blood in these veins.

Hemodynamic significance of the coronary vein valves

The incidence and morphology of one-way coronary vein valves were studied, together with their influence on the administration of retrograde cardioplegia. Calf, juvenile pig, and adult mongrel canine hearts (12 each) and human cadaver hearts (five adult and seven pediatric) were dissected. The pressure gradients between the coronary sinus and the posterior vein of the left ventricle were measured in 21 hearts during the retrograde administration of fluid. Species differences were noted, with apparently competent valves seen more frequently in calf hearts (mean, 1.33 valves ± 0.22 [SEM] per heart) than in pig hearts (mean, 0.83 ± 0.17 [SEM] per heart). In humans, more valves were seen in pediatric hearts (five valves in seven hearts) than in adult hearts (one valve in five hearts). No competent valves were found in dog hearts (X 2 analysis; p < 0.0001). In calf hearts, a pressure gradient of 5 to 35.5 mm Hg was required before the valve opened. In pig hearts, these opening pressure gradients ranged from 0 to 19.5 mm Hg. The distribution of retrograde cardioplegia may be impaired in the presence of competent valves, particularly when low coronary sinus pressures are used.