title: A detailed assessment of the human coronary venous system using contrast computed tomography of perfusion-fixed specimens.
abstract: BACKGROUND
  Access to the coronary venous system is required for the delivery of several cardiac therapies including cardiac resynchronization therapy, coronary sinus ablation, and coronary drug delivery. Therefore, characterization of the coronary venous anatomy will provide insights to gain improved access to these vessels and subsequently improved therapies. For example, cardiac resynchronization therapy has a 30% nonresponder rate, partially due to suboptimal lead placement within the coronary veins.
  
  
  OBJECTIVE
  To understand the implications of coronary venous anatomy for the development of devices deployed within these vessels.
  
  
  METHODS
  We cannulated the coronary sinus of 121 perfusion-fixed human hearts with a venogram balloon catheter and injected contrast into the venous system while obtaining computed tomographic images. For each major coronary vein, distance to the coronary sinus, branching angle, arc length, tortuosity, number of branches, and ostial diameter were assessed from the reconstructed anatomy.
  
  
  RESULTS
  Twenty-nine percent (35/121) specimens did not have a venous branch overlying the inferolateral side of the heart large enough to fit a 5F pacing lead. No significant differences in anatomy were found between subgroups with varying cardiac medical histories.
  
  
  CONCLUSIONS
  The anatomical approach employed in this study has allowed for the development of a unique database of human coronary venous anatomy that can be used for the optimization of design and delivery of cardiac devices.
authors.affiliation: University of Minnesota, Minneapolis, Minnesota.
authors.forename: Julianne H
authors.initials: JH
authors.lastname: Spencer
authors.affiliation: University of Minnesota, Minneapolis, Minnesota.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Larson
authors.affiliation: University of Minnesota, Minneapolis, Minnesota.
authors.forename: Rachel
authors.initials: R
authors.lastname: Drake
authors.affiliation: University of Minnesota, Minneapolis, Minnesota. Electronic address: iaizz001@umn.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Iaizzo
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D006801:Humans; D010477:Perfusion; D010690:Phlebography; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Anatomy; CHF; CRT; CT; Cardiac; Coronary; Pacing; Vein; cardiac resynchronization therapy; chronic heart failure; computed tomography