Morphologic and topologic characteristics of coronary venous system delineated by noninvasive multidetector computed tomography in chronic systolic heart failure patients.
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.


RESULTS
Multidetector computed tomography (MDCT) of the heart was investigated in 23 consecutive patients of chronic SHF with LV ejection fraction < or = 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 degrees) in SHF patients than that in normal (44 +/- 8 degrees, 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.
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
Jien-Jiun
JJ
Chen
Wen-Jeng
WJ
Lee
Yi-Chih
YC
Wang
Chia-Ti
CT
Tsai
Ling-Ping
LP
Lai
Juey-Jen
JJ
Hwang
Jiunn-Lee
JL
Lin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013599:Systole; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000502:physiology