title: The cardiac veins in congenitally corrected transposition of the great arteries: delivery options for cardiac devices.
abstract: BACKGROUND
  Device implantation is sometimes required in congenitally corrected transposition of the great arteries (ccTGA) because of morphologic right ventricular (RV) dysfunction and complete heart block. The anatomical course of the veins remains unknown, despite well-described coronary arterial anatomy. Knowledge of the venous anatomy may facilitate planning of percutaneous cardiac procedures in these patients.
  
  
  OBJECTIVE
  This study sought to characterize the venous anatomy in ccTGA.
  
  
  METHODS
  Pathologic cardiac specimens from patients with ccTGA were identified from the Mayo Clinic pathology database. Coronary sinus (CS) anatomy and distances from the CS ostium to the major cardiac veins were evaluated. Thebesian veins with ostial openings >1 mm, epicardial veins, and venous collaterals were also quantified.
  
  
  RESULTS
  There were 56 hearts with a diagnosis of ccTGA identified. The CS was unidentifiable in 5 hearts due to slicing, and assessment of the Thebesian veins was not possible in 16. Seven hearts had an abnormal CS, 2 of which had atretic ostia and the other 5 of which either had an abnormal ostial location or multiple ostia. There were 28 hearts with at least 1 Thebesian vein with an ostial opening >1 mm. All 12 hearts with unidentifiable Thebesian veins had venous collaterals from the right ventricle (RV) to the major cardiac veins. Epicardial veins extended to the proximal, middle, and distal thirds of the RV in 71%, 23%, and 6%, respectively.
  
  
  CONCLUSIONS
  In ccTGA, the ventricular venous anatomy is abnormal and follows the morphologic RV. However, large interventricular and Thebesian veins may offer options for percutaneous lead or catheter placement when approaching the systemic RV.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Bottega
authors.forename: Suraj
authors.initials: S
authors.lastname: Kapa
authors.forename: William D
authors.initials: WD
authors.lastname: Edwards
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Munger
authors.forename: Carole A
authors.initials: CA
authors.lastname: Warnes
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods; D003331:Coronary Vessels / Q000473:pathology*; D006801:Humans; D014188:Transposition of Great Vessels / Q000473:pathology*; D014680:Veins / Q000473:pathology