Morphologic and Topologic Characteristics of Coronary Venous System Delineated by Noninvasive Multidetector Computed Tomography in Chronic Systolic Heart Failure Patients

Chen, Jien-Jiun; Lee, Wen-Jeng; Wang, Yi-Chih; Tsai, Chia-Ti; Lai, Ling-Ping; Hwang, Juey-Jen; Lin, Jiunn-Lee

doi:10.1016/j.cardfail.2007.02.007

« Previous Next »Journal of Cardiac Failure
Volume 13, Issue 6 , Pages 482-488, August 2007

Morphologic and Topologic Characteristics of Coronary Venous System Delineated by Noninvasive Multidetector Computed Tomography in Chronic Systolic Heart Failure Patients

Jien-Jiun Chen, MD
- From the Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Wen-Jeng Lee, MD
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Yi-Chih Wang, MD
- From the Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Chia-Ti Tsai, MD, PhD
- From the Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Ling-Ping Lai, MD, PhD
- From the Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Juey-Jen Hwang, MD, PhD
- From the Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Jiunn-Lee Lin, MD, PhD
- From the Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
- Reprint requests: Jiunn-Lee Lin, MD, PhD, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, No 7, Chung-Shan South Road, Taipei, Taiwan, Republic of China.

Received 21 December 2006; received in revised form 16 February 2007; accepted 17 February 2007. published online 16 June 2007.

Taipei, Taiwan, Republic of China

Abstract

Background

Variations of coronary venous system in a dilated, failing heart may well be unpredictable. Noninvasive preview of coronary veins before left ventricular (LV) lead implantation for cardiac resynchronization therapy would facilitate successful procedure in chronic systolic heart failure (SHF) patients.

Methods and Results

Multidetector computed tomography (MDCT) of the heart was investigated in 23 consecutive patients of chronic SHF with LV ejection fraction ≤40%. Morphologic and topologic characteristics of coronary venous system were studied, and compared with 23 age-matched controls. All coronary veins including coronary sinus, posterior interventricular vein (PIV), LV posterior vein, left margin vein (LMV), and anterior interventricular vein (AIV) were clearly visible in all 23 SHF patients and 23 normal controls. Total coronary venous length (ie, from PIV to AIV) was directly correlated with LV volume (r = 0.65, P < .001). The main lengthened venous segment was between LMV and AIV. Ostial diameters of all coronary venous tributaries were larger in SHF patients, but the angle of branching was similar. However, the secondary angle of the coronary sinus relative to superior vena cava axis was more acute (30 ± 7°) in SHF patients than that in normal (44 ± 8°, P < .001). Local aneurysm locating at LV posterolateral wall could detour relevant coronary vein tributaries to the outer border of the aneurysm, compress venous dimensions throughout the cardiac cycle, and cause acute angulation of venous tributaries.

Conclusions

Coronary venous system shown by MDCT in SHF patients with low LV ejection fraction manifested longer venous length between LMV and AIV, acute secondary CS angle, and usually topologically distorted by posterolateral LV aneurysms. A panoramic delineation of all coronary venous tributaries could help effective venous intervention.

Key Words: Multidetector computed tomography, coronary vein, coronary sinus, systolic heart failure