title: Visualization of the cardiac venous system using cardiac magnetic resonance.
abstract: We sought to investigate the value of cardiac magnetic resonance to depict cardiac venous anatomy. For cardiac resynchronization therapy the lead for the left ventricle is usually placed by transvenous approach into a tributary of the coronary sinus (CS). Knowledge of the anatomy and variations of the cardiac venous system may facilitate the positioning of the left ventricle lead. The cardiac magnetic resonance examinations of 23 subjects (16 volunteers and 7 patients) were retrospectively analyzed. All examinations were performed using navigator-gated whole-heart steady-state free precession coronary artery imaging after administration of intravascular contrast agents (gadofosveset in volunteers; Gadomer-17 in patients). The cardiac venous system was visualized in all subjects. The most frequent anatomical variant observed (in 12 subjects [52%]) was a connection of the small cardiac vein to the CS at the crux cordis. In 10 subjects (44%) the small veins entered the right atrium independently from the CS, and the posterior interventricular vein was connected to the CS at the crux cordis. Only one subject had a disconnection between the CS and posterior interventricular vein, which entered into the right atrium independently. The mean distance of the posterior vein of the left ventricle and the left marginal vein to the ostium of the CS was 15.2+/-4.7 mm and 49.7+/-14.1 mm, respectively. In conclusion, the anatomy of the cardiac venous system and its anatomical variability can be described using cardiac magnetic resonance. Its preimplantation visualization may help to facilitate the implant procedure and to reduce fluoroscopy time.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Turin, Italy. amedeo.chiribiri@unito.it
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.forename: Stephan
authors.initials: S
authors.lastname: Götze
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kriatselis
authors.forename: Thomas
authors.initials: T
authors.lastname: Thouet
authors.forename: Tarinee
authors.initials: T
authors.lastname: Tangcharoen
authors.forename: Ingo
authors.initials: I
authors.lastname: Paetsch
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schnackenburg
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
mesh_terms: D003287:Contrast Media; D003331:Coronary Vessels / Q000033:anatomy & histology*; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C402765:gadomer 17; D005682:Gadolinium; C109932:gadofosveset trisodium