title: Impact of tricuspid regurgitation and prior coronary bypass surgery on the geometry of the coronary sinus: a rotational coronary angiography study.
abstract: BACKGROUND
  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).
  
  
  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 degrees, mean 119 +/- 19 degrees, <90 degrees in 8 patients) and decreased significantly (P = 0.0022) with increasing severity of tricuspid regurgitation (TR), reaching 94 +/- 18 degrees 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Blendea
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Saumya
authors.initials: S
authors.lastname: Das
authors.forename: Stephan
authors.initials: S
authors.lastname: Danik
authors.forename: Conor
authors.initials: C
authors.lastname: Barrett
authors.forename: Theofanie
authors.initials: T
authors.lastname: Mela
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*