open access

Vol 82, No 2 (2023)
Original article
Submitted: 2022-02-19
Accepted: 2022-04-07
Published online: 2022-04-28
Get Citation

Variations of coronary sinus tributaries among patients undergoing cardiac resynchronisation therapy

B. Gach-Kuniewicz1, G. Goncerz1, D. Ali1, M. Kacprzyk2, M. Zarzecki1, M. Loukas34, J. Walocha1, E. Mizia1
·
Pubmed: 35607878
·
Folia Morphol 2023;82(2):282-290.
Affiliations
  1. Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
  2. Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
  3. Department of Anatomical Sciences, St. George’s University, Grenada, West Indies
  4. Department of Anatomy, Varmia and Mazury University, Olsztyn, Poland

open access

Vol 82, No 2 (2023)
ORIGINAL ARTICLES
Submitted: 2022-02-19
Accepted: 2022-04-07
Published online: 2022-04-28

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.

Get Citation

Keywords

coronary sinus, resynchronization therapy, heart failure

About this article
Title

Variations of coronary sinus tributaries among patients undergoing cardiac resynchronisation therapy

Journal

Folia Morphologica

Issue

Vol 82, No 2 (2023)

Article type

Original article

Pages

282-290

Published online

2022-04-28

Page views

2341

Article views/downloads

795

DOI

10.5603/FM.a2022.0044

Pubmed

35607878

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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