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Variations of coronary sinus tributaries among patients undergoing cardiac resynchronisation therapy
, 1, 1, 2, 1, 34, 1, 1
Affiliations- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Anatomical Sciences, St. George’s University, Grenada, West Indies
- Department of Anatomy, Varmia and Mazury University, Olsztyn, Poland
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Abstract
Background: 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.
Materials and methods: 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.
Results: 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.
Conclusions: 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.
Abstract
Background: 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.
Materials and methods: 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.
Results: 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.
Conclusions: 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.
Keywords
coronary sinus, resynchronization therapy, heart failure
About this articleTitle
Variations of coronary sinus tributaries among patients undergoing cardiac resynchronisation therapy
Journal
Issue
Article type
Original article
Pages
282-290
Published online
2022-04-28
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2351
Article views/downloads
808
DOI
Pubmed
Bibliographic record
Folia Morphol 2023;82(2):282-290.
Keywords
coronary sinus
resynchronization therapy
heart failure
Authors
B. Gach-Kuniewicz
G. Goncerz
D. Ali
M. Kacprzyk
M. Zarzecki
M. Loukas
J. Walocha
E. Mizia
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