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Variance in Coronary Venous Anatomy: A Critical Determinant in Optimal Candidate Selection for Cardiac Resynchronization Therapy
Author(s) -
RANDHAWA ARPANDEEP,
SAINI ABHIMANYU,
AGGARWAL ANJALI,
ROHIT MANOJ K.,
SAHNI DAISY
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12026
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , selection (genetic algorithm) , variance (accounting) , heart failure , artificial intelligence , ejection fraction , business , accounting , computer science
Background Knowledge of coronary sinus (CS) anatomy and its variations is one of the important factors determining the final position of left ventricle pacing lead during cardiac resynchronization therapy. Methods Coronary venous system anatomy, including number, diameter, and opening angles of tributaries, was studied in 50 normal formalin‐fixed adult cadaveric hearts . Results Thebesian valve (TV) and Vieussens valve were present in 64% and 60% cases, respectively. CS ostium coverage of ≥75% by TV was seen in 25% (8/32) cases. Number of prominent tributaries lying between anterior interventricular vein and middle cardiac vein varied from 1–4. In 28% of hearts, only one prominent tributary was present. Midlateral vein (average diameter 1.75 ± 0.66 mm) with an average distance of 43.5 ± 12.2 mm from coronary ostium was present in 58% (29/50) hearts, of which it formed an acute angle with CS axis in four (13.39%) cases. Posterolateral vein (average diameter 1.62 ± 0.45 mm) with an average distance of 33.4 ± 11.7 mm from coronary ostium was found in 72% (36/50) cases and formed an acute angle with CS in three (8.33%) cases . Conclusions Restrictive TV covering ≥75% CS ostium (25% cases), presence of single prominent tributary (28% cases), and formation of acute angle of tributary with CS axis (1/4 cases with anterolateral vein, 4/29 cases with midlateral vein, 3/36 cases with posterolateral vein, and 3/28 cases with posterior veins of the left ventricle) can impede successful cannulation of CS . (PACE 2013; 36:94–102)