TY - JOUR
T1 - Morphologic and Topologic Characteristics of Coronary Venous System Delineated by Noninvasive Multidetector Computed Tomography in Chronic Systolic Heart Failure Patients
AU - Chen, Jien Jiun
AU - Lee, Wen Jeng
AU - Wang, Yi Chih
AU - Tsai, Chia Ti
AU - Lai, Ling Ping
AU - Hwang, Juey Jen
AU - Lin, Jiunn Lee
PY - 2007/8/1
Y1 - 2007/8/1
N2 - 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.
AB - 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.
KW - coronary sinus
KW - coronary vein
KW - Multidetector computed tomography
KW - systolic heart failure
KW - coronary sinus
KW - coronary vein
KW - Multidetector computed tomography
KW - systolic heart failure
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U2 - 10.1016/j.cardfail.2007.02.007
DO - 10.1016/j.cardfail.2007.02.007
M3 - Article
C2 - 17675063
AN - SCOPUS:34547470457
SN - 1071-9164
VL - 13
SP - 482
EP - 488
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 6
ER -