Eur J Anat, 24 (5): 357-361 (2020)

Coronary venous anatomy relevant to cardiac resynchronization therapyan angiographic study

Priyanka Ramanathan¹, Girija Agarwal¹, Raja Selvaraj², Raveendranath Veeramani³

¹Jawaharlal Institute of Postgraduate Medical Education and Research [JIPMER], Dhanvantri Nagar, Pondicherry -605006, India, ²Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research [JIPMER], Dhanvantri Nagar, Pondicherry -605006, India, ³Department of Anatomy, Jawaharlal Institute of Postgradu-ate Medical Education and Research [JIPMER], Dhanvantri Nagar, Pondicherry -605006, India

ABSTRACT Cardiac resynchronization therapy (CRT) in-volves placing a lead through the coronary sinus to pace the left ventricle. However, technical prob-lems arise in the procedure either due to variant anatomy or due to the presence of valves. Infor-mation on coronary venous anatomy is scarce in the South Indian population. The aim of this study was to describe the coronary sinus anatomy in patients undergoing CRT implant. Coronary sinus angiograms were used to study the following pa-rameters: (a) Dimensions of coronary sinus (b) Number and distribution of tributaries (excluding middle and great cardiac veins) (c) Diameter of major veins at the origin (d) Angulation of tributar-ies with CS. Measurements were made using cali-pers in the dicom viewer.Out of the 24 angiograms studied, only a single tributary of adequate size was noted in 70.8% (17/24) of the cases, which was most commonly a midlateral vein (76.5%). Two prominent tributaries were noted in 29.2% (7/24) of cases. The average diameter of the veins was 3.93 mm and 80.6% of the veins had an obtuse angle of drainage. Ana-tomical variations in the coronary venous systemin this population suggest that the majority of pa-tients have a single suitable tributary and this is most often the midlateral vein, which is known to have the most favorable outcome. Data obtained in this study will guide clinicians in left ventricular lead placement in the South Indian population leading to greater procedural success.

Keywords: Cardiac resynchronization therapy (CRT) â?? Pacemaker â?? Coronary veins â?? Coronary sinus â?? Anatomy