title: Anatomical Consideration and Potential Complications of Coronary Sinus Catheterisation.
abstract: BACKGROUND
  Coronary venous catheterisation has been used for performing various cardiologic interventions. The procedure might become complicated due to obstruction offered by the valve of coronary sinus (Thebesian valve) the acute bend of the Great Cardiac Vein (GCV). The present study sought to expound the anatomical considerations of coronary venous catheterization and to elucidate the potential causes of obstruction and the complications of this procedure.
  
  
  METHODS
  In this cross-sectional observational study, coronary sinus and GCV were dissected in 40, formalin fixed, adult cadaveric human hearts. Course, length, diameter and angle of bend of GCV, length of coronary sinus and its diameter at its ostium in right atrium were recorded. Thebesian valve morphology and percentage coverage of coronary sinus ostium was recorded. Relation of the coronary sinus and GCV with their neighbouring arteries was described.
  
  
  RESULTS
  Coronary sinus: near its termination was directly related to the left atrium. Length: 35.35±4.43 mm (1 SD). Diameter: 11.75 ± 2.66mm. Diameter of CS ostium was more in hearts where Thebesian valve was absent. GCV travelled superficial or deep to the left diagonal artery and crossed circumflex artery superficially. Length: 96.23 ±22.52mm. Diameter: 5.99 ±1.02mm. Angle of bend: 107 ±6.74 degrees. Thebesian valve: Absent in 3 hearts. Various morphologies were observed: thin band, thin band with fenestrations, broad band with fenestrations, well developed semilunar valve (Thin/thick). In five hearts, valve covered more than 50% of coronary sinus ostium.
  
  
  CONCLUSIONS
  Coronary sinus and GCV diameter will help cardiologists and cardiothoracic surgeons to choose an appropriate sized catheter and their length will decide the length of catheter advancement. Thebesian valve may cause obstruction to the catheter due to an extensive coverage of coronary sinus ostium, which is seen in 12.5% cases. The obtuse angle of GCV has to be negotiated in order to enter this vessel. Arteries lying deep to coronary sinus and GCV might be compressed leading to myocardial ischemia.
authors.affiliation: Senior Resident, Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India .
authors.forename: Lalit
authors.initials: L
authors.lastname: Mehra
authors.affiliation: Director Professor, Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India .
authors.forename: Shashi
authors.initials: S
authors.lastname: Raheja
authors.affiliation: Professor, Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India .
authors.forename: Sneh
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Professor, Department of Forensic Medicine and Toxicology, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India .
authors.forename: Yashoda
authors.initials: Y
authors.lastname: Rani
authors.affiliation: Associate Professor, Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India .
authors.forename: Kulwinder
authors.initials: K
authors.lastname: Kaur
authors.affiliation: Director Professor and Head, Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India .
authors.forename: Anita
authors.initials: A
authors.lastname: Tuli
keywords: Anatomy; Great cardiac vein; Thebesian valve