title: Spatial relationship of coronary sinus-great cardiac vein with adjoining anatomic structures: a key element in predicting the success of percutaneous transvenous mitral annuloplasty.
abstract: OBJECTIVE
  Knowledge of the anatomy of the coronary venous system and its relationship with the mitral valve annulus (MVA) and coronary arteries is a key element to successful percutaneous transvenous mitral annuloplasty (PTMA) device implantation for treating patients with severe mitral regurgitation.
  
  
  METHODS
  The spatial relationship of the coronary sinus-great cardiac vein (CS-GCV) with the MVA, left circumflex coronary artery (LCx) and its branches was examined in 120 formalin-fixed adult human cadaveric hearts.
  
  
  RESULTS
  During the initial part of its journey, the CS-GCV was seen to course along and parallel to the plane of the MVA in 109 cases (90.8%), and to cross the MVA obliquely in 11 cases (9.2%). The LCx crossed deep or superficial to the CS-GCV at a discrete point in 98 cases (81.6%) and in eight cases (6.6%), respectively. In two cases (1.6%), the LCx was overlapped by the CS-GCV for an average length of 3.5 +/- 0.7 cm, and in five cases (4.1%) it lay superficial to the CS-GCV for an average length of 3.1 +/- 1.0 cm. In the remaining seven cases (5.8%), the artery did not accompany the CS-GCV along the MVA. Obtuse marginal arteries and the ramus intermedius were seen coursing deep to the CS-GCV in 40 cases (33.3%) and 33 cases (27.5%), respectively.
  
  
  CONCLUSIONS
  The study results showed that the CS-GCV crosses the annulus obliquely in 9.2% of cases, and hence might affect the efficiency of PTMA. Similarly, positioning of the annuloplasty device in the CS-GCV in cases where the LCx and its branches lay deep to the vein may result in an impingement of the arteries, leading to ischemia.
authors: Daisy
authors: D
authors: Sahni
authors: Arpandeep
authors: A
authors: Randhawa
authors: Anjali
authors: A
authors: Aggarwal
authors: Manoj K
authors: MK
authors: Rohit
mesh_terms: D059925:Anatomic Landmarks; D002102:Cadaver; D054326:Coronary Sinus / Q000033:anatomy & histology*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008943:Mitral Valve / Q000033:anatomy & histology*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation; D011474:Prosthesis Design