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Impact of Tricuspid Regurgitation and Prior Coronary Bypass Surgery on the Geometry of the Coronary Sinus: A Rotational Coronary Angiography Study
Author(s) -
BLENDEA DAN,
HEIST E. KEVIN,
DAS SAUMYA,
DANIK STEPHAN,
BARRETT CONOR,
MELA THEOFANIE,
RUSKIN JEREMY N.,
SINGH JAGMEET P.
Publication year - 2010
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2009.01639.x
Subject(s) - medicine , coronary sinus , cardiology , great cardiac vein , artery , coronary vein
Coronary Venous Geometry in Patients Undergoing CRT . Introduction: The coronary sinus (CS) is often distorted in patients with advanced cardiomyopathy, making CS cannulation difficult. The objective of this study was to examine the impact of the underlying cardiac pathology on the variability of the CS anatomy, using rotational coronary venous angiography (RCVA).Methods and Results:Seventy‐nine patients undergoing RCVA for cardiac resynchronization therapy (CRT) were evaluated: age 63 ± 15 years, 43% with prior coronary artery bypass grafting (CABG). Aspects of the CS anatomy which could impact cannulation were examined: the CS ostial angle, the posterior displacement of the CS away from the atrioventricular groove, a measure of CS curvature, and the presence of stenoses and aneurysmal dilatations. The CS ostial angle was variable (65–151°, mean 119 ± 19°, <90° in 8 patients) and decreased significantly (P = 0.0022) with increasing severity of tricuspid regurgitation (TR), reaching 94 ± 18° in patients with severe TR. The posterior displacement of the CS was significantly more accentuated in patients with prior CABG when compared with the patients without CABG (7.1 ± 3.7 vs 4.5 ± 2.8 mm; P = 0.0246). The decrease in luminal diameter at the CS–great cardiac vein (GCV) junction was 2.0 ± 1.0 mm, being more pronounced in patients with prior CABG versus nonCABG (26 vs 20%; P = 0.042). Stenoses and aneurysmal dilatations of the CS–GCV were encountered in 4 (5%) and 6 (8%) of patients, respectively, all of them with prior CABG, representing 12% and 18% of the CABG group.Conclusion:The CS anatomy in patients undergoing CRT is variable, and is impacted by the severity of the underlying TR and history of a prior CABG. (J Cardiovasc Electrophysiol, Vol. 21, pp. 436–440, April 2010)