Morphologic and Topologic Characteristics of Coronary Venous System Delineated by Noninvasive Multidetector Computed Tomography in Chronic Systolic Heart Failure Patients

Jien Jiun Chen, Wen Jeng Lee, Yi Chih Wang, Chia Ti Tsai, Ling Ping Lai, Juey Jen Hwang, Jiunn Lee Lin

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Variations of coronary venous system in a dilated, failing heart may well be unpredictable. Noninvasive preview of coronary veins before left ventricular (LV) lead implantation for cardiac resynchronization therapy would facilitate successful procedure in chronic systolic heart failure (SHF) patients. Methods and Results: Multidetector computed tomography (MDCT) of the heart was investigated in 23 consecutive patients of chronic SHF with LV ejection fraction ≤40%. Morphologic and topologic characteristics of coronary venous system were studied, and compared with 23 age-matched controls. All coronary veins including coronary sinus, posterior interventricular vein (PIV), LV posterior vein, left margin vein (LMV), and anterior interventricular vein (AIV) were clearly visible in all 23 SHF patients and 23 normal controls. Total coronary venous length (ie, from PIV to AIV) was directly correlated with LV volume (r = 0.65, P < .001). The main lengthened venous segment was between LMV and AIV. Ostial diameters of all coronary venous tributaries were larger in SHF patients, but the angle of branching was similar. However, the secondary angle of the coronary sinus relative to superior vena cava axis was more acute (30 ± 7°) in SHF patients than that in normal (44 ± 8°, P < .001). Local aneurysm locating at LV posterolateral wall could detour relevant coronary vein tributaries to the outer border of the aneurysm, compress venous dimensions throughout the cardiac cycle, and cause acute angulation of venous tributaries. Conclusions: Coronary venous system shown by MDCT in SHF patients with low LV ejection fraction manifested longer venous length between LMV and AIV, acute secondary CS angle, and usually topologically distorted by posterolateral LV aneurysms. A panoramic delineation of all coronary venous tributaries could help effective venous intervention.

Original languageEnglish
Pages (from-to)482-488
Number of pages7
JournalJournal of Cardiac Failure
Volume13
Issue number6
DOIs
Publication statusPublished - Aug 1 2007
Externally publishedYes

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Keywords

  • coronary sinus
  • coronary vein
  • Multidetector computed tomography
  • systolic heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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