Anatomy of the coronary sinus and epicardial coronary venous system in 620 hearts: An electrophysiology perspective

Amit Noheria, Christopher V. Desimone, Nirusha Lachman, William D. Edwards, Apoor S. Gami, Joseph Maleszewski, Paul Andrew Friedman, Thomas M. Munger, Stephen C. Hammill, David L. Hayes, Douglas L Packer, Samuel J Asirvatham

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Anatomy of the Coronary Venous System. Introduction: Cannulation of the coronary sinus (CS) is a prerequisite for left ventricular (LV) pacing and certain ablation procedures. The detailed regional anatomy for the coronary veins and potential anatomic causes for difficulty with these procedures has not been established. Methods and Results: Therefore, we performed macroscopic measurements in 620 autopsied hearts (mean age 60 ± 23 years, 44% female). The CS was preserved for analysis in 96%. Sixty-three percent had a Thebesian valve that covered the posterior aspect of the CS ostium with extension to the superior (50%) and inferior aspects (18%) and was obstructive with fenestrations in 3 specimens. Partial or near occlusive valves were present occasionally at the ostium of the great cardiac vein (Vieussens; 8%) and middle cardiac vein (5%). Ninety-three percent had left atrial branches, and 41% had at least one branch with lumen > 3 French. For CRT lead placement, the mid-lateral LV was accessible from the middle cardiac vein (20%), the left posterior vein (92%) or the anterior interventricular vein (86%). Among specimens where the left phrenic nerve was preserved it crossed the LV mid-lateral wall in 45%. Conclusions: Epicardial coronary vein anatomy is variable, and the mid-lateral LV wall can potentially be accessed through various tributaries of the epicardial veins. The orientation of the Thebesian valve favors cannulation of the CS from an anterior (ventricular) and inferior approach. Anterobasal, mid-lateral, and inferior apical LV coronary veins lie in proximity to the course of the phrenic nerve.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume24
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Coronary Sinus
Electrophysiology
Veins
Anatomy
Coronary Vessels
Phrenic Nerve
Catheterization
Regional Anatomy

Keywords

  • cardiac anatomy
  • catheter ablation
  • coronary sinus
  • left ventricular pacing
  • phrenic nerve
  • ventricular veins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Anatomy of the coronary sinus and epicardial coronary venous system in 620 hearts : An electrophysiology perspective. / Noheria, Amit; Desimone, Christopher V.; Lachman, Nirusha; Edwards, William D.; Gami, Apoor S.; Maleszewski, Joseph; Friedman, Paul Andrew; Munger, Thomas M.; Hammill, Stephen C.; Hayes, David L.; Packer, Douglas L; Asirvatham, Samuel J.

In: Journal of Cardiovascular Electrophysiology, Vol. 24, No. 1, 01.2013, p. 1-6.

Research output: Contribution to journalArticle

Noheria, Amit ; Desimone, Christopher V. ; Lachman, Nirusha ; Edwards, William D. ; Gami, Apoor S. ; Maleszewski, Joseph ; Friedman, Paul Andrew ; Munger, Thomas M. ; Hammill, Stephen C. ; Hayes, David L. ; Packer, Douglas L ; Asirvatham, Samuel J. / Anatomy of the coronary sinus and epicardial coronary venous system in 620 hearts : An electrophysiology perspective. In: Journal of Cardiovascular Electrophysiology. 2013 ; Vol. 24, No. 1. pp. 1-6.
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abstract = "Anatomy of the Coronary Venous System. Introduction: Cannulation of the coronary sinus (CS) is a prerequisite for left ventricular (LV) pacing and certain ablation procedures. The detailed regional anatomy for the coronary veins and potential anatomic causes for difficulty with these procedures has not been established. Methods and Results: Therefore, we performed macroscopic measurements in 620 autopsied hearts (mean age 60 ± 23 years, 44{\%} female). The CS was preserved for analysis in 96{\%}. Sixty-three percent had a Thebesian valve that covered the posterior aspect of the CS ostium with extension to the superior (50{\%}) and inferior aspects (18{\%}) and was obstructive with fenestrations in 3 specimens. Partial or near occlusive valves were present occasionally at the ostium of the great cardiac vein (Vieussens; 8{\%}) and middle cardiac vein (5{\%}). Ninety-three percent had left atrial branches, and 41{\%} had at least one branch with lumen > 3 French. For CRT lead placement, the mid-lateral LV was accessible from the middle cardiac vein (20{\%}), the left posterior vein (92{\%}) or the anterior interventricular vein (86{\%}). Among specimens where the left phrenic nerve was preserved it crossed the LV mid-lateral wall in 45{\%}. Conclusions: Epicardial coronary vein anatomy is variable, and the mid-lateral LV wall can potentially be accessed through various tributaries of the epicardial veins. The orientation of the Thebesian valve favors cannulation of the CS from an anterior (ventricular) and inferior approach. Anterobasal, mid-lateral, and inferior apical LV coronary veins lie in proximity to the course of the phrenic nerve.",
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KW - catheter ablation

KW - coronary sinus

KW - left ventricular pacing

KW - phrenic nerve

KW - ventricular veins

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