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Tashiro K, Komaki T, Ideishi A, Mohri N, Miura SI, Ogawa M. Distinct single spiky component of local abnormal ventricular activity and accurate identification of origin of premature ventricular complexes arising from left ventricular summit. HeartRhythm Case Rep 2024; 10:182-185. [PMID: 38496738 PMCID: PMC10943545 DOI: 10.1016/j.hrcr.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Kohei Tashiro
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
- Endowed Department of Advanced Therapeutics for Cardiovascular Disease, Fukuoka University, Fukuoka, Japan
| | - Tomo Komaki
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Akihito Ideishi
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Noriyuki Mohri
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Masahiro Ogawa
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
- Endowed Department of Advanced Therapeutics for Cardiovascular Disease, Fukuoka University, Fukuoka, Japan
- Department of Clinical Laboratory Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Lanik WE, McCumber TL, Sayyed S, Hovseth C, Snow EL. Case analysis of a RIII-C single coronary artery with type IV dual LAD and right-dominant triple PDA. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Kulkarni V, HT G, Lokanathan TH. Morphometry of the Great Cardiac Vein in Cadaveric Hearts of South Indian Origin. Cureus 2022; 14:e23460. [PMID: 35371866 PMCID: PMC8948444 DOI: 10.7759/cureus.23460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction In recent years, rapid developments in procedures like cardiac pacing, targeted drug therapy, and trans coronary venous ablation have necessitated a need for a detailed study of cardiac venous anatomy. Because the number, diameter, and course of the coronary veins vary, extensive information on the patient's specific anatomy is required for the best planning of the treatment. With this background, we planned the current research to analyze the anatomy of the great cardiac vein (GCV) in terms of length and diameter, provide a formula for calculating diameter using linear regression analysis and report the frequency of formation of the triangle of Brocq and Mouchet. Methods We conducted this cross-sectional study on fifty-two adult human cadaveric hearts of South Indian origin collected during dissection classes for undergraduate medical students. We measured the GCV's length and diameter and applied the linear regression analysis to derive a formula for estimating the diameter of the GCV. We also noted the frequency of formation of the triangle of Brocq and Mouchet and presented it as a percentage. Results The mean length and width of the GCV were 67.77 mm and 2.76 mm, respectively. The formula obtained after linear regression analysis for calculating the diameter of the GCV was: the diameter of GCV=0.0089 (length of GCV vein) ± 2.147. The triangle of Brocq and Mouchet with GCV as the base was present in 97% of the hearts. Conclusion The length and diameter of the GCV reported in the current study were considerably lesser than the reported findings in the literature. These findings suggest significant variations in the anatomy of the cardiac veins and call for further research on the anatomy of cardiac veins.
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Left Ventricular Summit-Concept, Anatomical Structure and Clinical Significance. Diagnostics (Basel) 2021; 11:diagnostics11081423. [PMID: 34441357 PMCID: PMC8393416 DOI: 10.3390/diagnostics11081423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023] Open
Abstract
The left ventricular summit (LVS) is a triangular area located at the most superior portion of the left epicardial ventricular region, surrounded by the two branches of the left coronary artery: the left anterior interventricular artery and the left circumflex artery. The triangle is bounded by the apex, septal and mitral margins and base. This review aims to provide a systematic and comprehensive anatomical description and proper terminology in the LVS region that may facilitate exchanging information among anatomists and electrophysiologists, increasing knowledge of this cardiac region. We postulate that the most dominant septal perforator (not the first septal perforator) should characterize the LVS definition. Abundant epicardial adipose tissue overlying the LVS myocardium may affect arrhythmogenic processes and electrophysiological procedures within the LVS region. The LVS is divided into two clinically significant regions: accessible and inaccessible areas. Rich arterial and venous coronary vasculature and a relatively dense network of cardiac autonomic nerve fibers are present within the LVS boundaries. Although the approach to the LVS may be challenging, it can be executed indirectly using the surrounding structures. Delivery of the proper radiofrequency energy to the arrhythmia source, avoiding coronary artery damage at the same time, may be a challenge. Therefore, coronary angiography or cardiac computed tomography imaging is strongly recommended before any procedure within the LVS region. Further research on LVS morphology and physiology should increase the safety and effectiveness of invasive electrophysiological procedures performed within this region of the human heart.
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Motonaga KS, Hsia HH. Road to the Summit May Follow an Eccentric Path. Circ Arrhythm Electrophysiol 2019; 12:e007691. [PMID: 31401855 DOI: 10.1161/circep.119.007691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kara S Motonaga
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CA (K.S.M.)
| | - Henry H Hsia
- the Department of Medicine, Division of Cardiology, University of California San Francisco (H.H.H.)
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Sirajuddin A, Chen MY, White CS, Arai AE. Coronary venous anatomy and anomalies. J Cardiovasc Comput Tomogr 2019; 14:80-86. [PMID: 31444098 DOI: 10.1016/j.jcct.2019.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/06/2019] [Indexed: 01/01/2023]
Abstract
Coronary venous anatomy can be divided into the greater cardiac venous system and the lesser cardiac venous system. With protocol optimization, including appropriate contrast bolus timing, coronary veins can be depicted with excellent detail on CT. Knowledge of variant coronary venous anatomy can sometimes play a role in pre-procedural planning. Analysis of the coronary venous anatomy on CT can detect coronary venous anomalies that cause right to left shunts with risk of stroke, left to right shunts, and arrhythmias.
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Affiliation(s)
- Arlene Sirajuddin
- National Heart, Lung and Blood Institute, National Institute of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD, 20892, USA.
| | - Marcus Y Chen
- National Heart, Lung and Blood Institute, National Institute of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Charles S White
- Department of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Andrew E Arai
- National Heart, Lung and Blood Institute, National Institute of Health, Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD, 20892, USA
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Cheung JW, Anderson RH, Markowitz SM, Lerman BB. Catheter Ablation of Arrhythmias Originating From the Left Ventricular Outflow Tract. JACC Clin Electrophysiol 2019; 5:1-12. [DOI: 10.1016/j.jacep.2018.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/13/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022]
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Genain MA, Morlet A, Herrtage M, Muresian H, Anselme F, Latremouille C, Laborde F, Behr L, Borenstein N. Comparative anatomy and angiography of the cardiac coronary venous system in four species: human, ovine, porcine, and canine. J Vet Cardiol 2018; 20:33-44. [DOI: 10.1016/j.jvc.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/28/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
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Koruth JS, D'Avila A. Has Catheter Ablation Reached Its Peak for Left Ventricle Summit Arrhythmias? Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004647. [PMID: 27729342 DOI: 10.1161/circep.116.004647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacob S Koruth
- From the Leona M. and Harvey B. Helmsley Electrophysiology Center, Zena and Michael A. Weiner Cardiovascular Center, Mount Sinai Medical Center, New York, NY (J.S.K.); and Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, SC, Brazil (A.D'A.)
| | - Andre D'Avila
- From the Leona M. and Harvey B. Helmsley Electrophysiology Center, Zena and Michael A. Weiner Cardiovascular Center, Mount Sinai Medical Center, New York, NY (J.S.K.); and Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, SC, Brazil (A.D'A.).
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Santangeli P, Callans DJ. Idiopathic Outflow Tract Ventricular Arrhythmia Ablation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004537. [DOI: 10.1161/circep.116.004537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pasquale Santangeli
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - David J. Callans
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
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11
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Obstructive Thebesian valve: anatomical study and implications for invasive cardiologic procedures. Anat Sci Int 2013; 89:85-94. [DOI: 10.1007/s12565-013-0203-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
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12
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Kim SY, Hong YJ, Lee HJ, Hur J, Choi BW, Kim YJ. Anomalous great cardiac vein draining into the right atrium combined with a single left coronary artery. Int J Cardiovasc Imaging 2013; 29 Suppl 1:53-6. [PMID: 23443338 DOI: 10.1007/s10554-013-0195-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Abstract
In contrast to the coronary arterial system, little attention has been paid to the coronary venous system in previous literature. We report a rare case of a combined anomaly of the coronary artery and the great cardiac vein (GCV). In this patient, the right coronary artery (RCA) arose from the left coronary artery, and the GCV drained directly into the right atrium. The anomalous RCA and GCV ran parallel courses along the anterior side of the right ventricular outflow tract. We briefly review the clinical significance and the role of cardiac computed tomography in this anomaly.
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Affiliation(s)
- Soo-Yeon Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
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Saremi F, Muresian H, Sánchez-Quintana D. Coronary Veins: Comprehensive CT-Anatomic Classification and Review of Variants and Clinical Implications. Radiographics 2012; 32:E1-32. [DOI: 10.1148/rg.321115014] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Minden HH. [Technical innovations and limitation in cardiac electrotherapy]. Herzschrittmacherther Elektrophysiol 2011; 22:11-5. [PMID: 21344233 DOI: 10.1007/s00399-011-0117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coronary sinus (CS) lead positioning is one of the main determinants of cardiac resynchronization therapy (CRT). The implantation of the CS lead is faced with several technical difficulties that may prevent the achievement of a stable position and good performance of the CS lead without phrenic nerve stimulation (PNS). New developments in catheter and lead technology to overcome these difficulties are presented.
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Affiliation(s)
- H-H Minden
- Klinik für Innere Medizin/Kardiologie, Oberhavel-Kliniken, Marwitzer Str. 91, 16761, Hennigsdorf, Deutschland.
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Mlynarski R, Mlynarska A, Sosnowski M. Anatomical Variants of Coronary Venous System on Cardiac Computed Tomography. Circ J 2011; 75:613-8. [DOI: 10.1253/circj.cj-10-0736] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rafal Mlynarski
- Department of Electrocardiology, Upper-Silesian Medical Center
- Unit of Noninvasive Cardiovascular Diagnostics, Upper-Silesian Medical Center
| | | | - Maciej Sosnowski
- Unit of Noninvasive Cardiovascular Diagnostics, Upper-Silesian Medical Center
- 3rd Division of Cardiology, Medical University of Silesia
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Kaimovitz B, Lanir Y, Kassab GS. A full 3-D reconstruction of the entire porcine coronary vasculature. Am J Physiol Heart Circ Physiol 2010; 299:H1064-76. [PMID: 20622105 PMCID: PMC2957345 DOI: 10.1152/ajpheart.00151.2010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 07/08/2010] [Indexed: 11/22/2022]
Abstract
We have previously reconstructed the entire coronary arterial tree of the porcine heart down to the first segment of capillaries. Here, we extend the vascular model through the capillary bed and the entire coronary venous system. The reconstruction was based on comprehensive morphometric data previously measured in the porcine heart. The reconstruction was formulated as a large-scale optimization process, subject to both global constraints relating to the location of the larger veins and to local constraints of measured morphological features. The venous network was partitioned into epicardial, transmural, and perfusion functional subnetworks. The epicardial portion was generated by a simulated annealing search for the optimal coverage of the area perfused by the arterial epicardial vessels. The epicardial subnetwork and coronary arterial capillary network served as boundary conditions for the reconstruction of the in-between transmural and perfusion networks, which were generated to optimize vascular homogeneity. Five sets of full coronary trees, which spanned the entire network down to the capillary level, were reconstructed. The total number of reconstructed venous segments was 17,148,946 ± 1,049,498 (n = 5), which spanned the coronary sinus (order -12) to the first segment of the venous capillary (order 0v). Combined with the reconstructed arterial network, the number of vessel segments for the entire coronary network added up to 27,307,376 ± 1,155,359 (n = 5). The reconstructed full coronary vascular network agreed with the gross anatomy of coronary networks in terms of structure, location of major vessels, and measured morphometric statistics of native coronary networks. This is the first full model of the entire coronary vasculature, which can serve as a foundation for realistic large-scale coronary flow analysis.
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Affiliation(s)
- Benjamin Kaimovitz
- Faculty of Biomedical Engineering, Israel Institute of Technology, Haifa, Israel
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Saremi F, Channual S, Sarlaty T, Tafti MA, Milliken JC, Narula J. Coronary Venous Aneurysm in Patients Without Cardiac Arrhythmia as Detected by MDCT. JACC Cardiovasc Imaging 2010; 3:257-65. [DOI: 10.1016/j.jcmg.2009.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 09/10/2009] [Accepted: 09/11/2009] [Indexed: 10/19/2022]
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Khan FZ, Virdee MS, Gopalan D, Rudd J, Watson T, Fynn SP, Dutka DP. Characterization of the suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy. Europace 2009; 11:1491-5. [DOI: 10.1093/europace/eup292] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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[Optimal electrode placement. What to consider during implantation of a biventricular pacemaker?]. Herzschrittmacherther Elektrophysiol 2009; 20:109-20. [PMID: 19730925 DOI: 10.1007/s00399-009-0051-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 08/19/2009] [Indexed: 10/19/2022]
Abstract
Since the introduction of transvenous left ventricular lead systems nearly a decade ago, resynchronization therapy has gained widespread acceptance and has become a growing field in heart failure therapy. Due to the increasing numbers of implanting centers and physicians, the need for adequate education is increasing. This article describes and illustrates the anatomical background, the technical opportunities and pitfalls, which have to be overcome, to achieve an implanting success rate of 95% to 98%, as can be achieved by well-trained physicians under optimal conditions.
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Loukas M, Bilinsky S, Bilinsky E, El-Sedfy A, Anderson RH. Cardiac veins: A review of the literature. Clin Anat 2009; 22:129-45. [DOI: 10.1002/ca.20745] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Loukas M, Tubbs RS. Intersection patterns of human coronary veins and arteries. Anat Sci Int 2008; 83:179-80; author reply 181. [DOI: 10.1111/j.1447-073x.2008.00237.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loukas M, Tubbs RS, Jordan R. Aneurysm of the great cardiac vein. Surg Radiol Anat 2007; 29:169-72. [PMID: 17242871 DOI: 10.1007/s00276-006-0176-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 12/04/2006] [Indexed: 11/28/2022]
Abstract
Anatomical variations in the cardiac veins have the potential to cause iatrogenic injuries during cardiac surgical procedures or cardiac resynchronization therapy. We present a case of an 86-year-old man, which presented with a great cardiac vein aneurysm. The great cardiac vein arose near the apex of the interventricular sulcus to the right of the anterior interventricular branch (AIB) of the left coronary artery and crossed the AIB anteriorly to the left. The great cardiac vein aneurysm appeared to be due to a possible distal constriction of the great cardiac vein by a small muscular branch of the circumflex branch and a possible proximal constriction by the left marginal artery. Cardiologists who interpret imaging of the cardiac veins and cardiac surgeons who operate close to the great cardiac vein should be aware of such a variation.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies.
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Singh JP, Houser S, Heist EK, Ruskin JN. The Coronary Venous Anatomy. J Am Coll Cardiol 2005; 46:68-74. [PMID: 15992638 DOI: 10.1016/j.jacc.2005.04.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Revised: 03/23/2005] [Accepted: 04/05/2005] [Indexed: 12/14/2022]
Abstract
The coronary sinus is the gateway for left ventricular (LV) epicardial lead placement for cardiac resynchronization therapy. The implanting electrophysiologist is usually challenged by a high degree of variability in the coronary venous anatomy, making it important to have a more consistent and uniform segmental approach to describe the coronary venous tree and its branches. Classifying the coronary sinus branches and tributaries by the segment of their location rather than by conventional anatomic names (i.e., middle cardiac vein, great cardiac vein, and so on), would provide more relevant anatomic and functional information at the time of LV lead placement. This would enable the implanting physician to proactively correlate the venous anatomy with the segmental wall motion abnormalities or dyssynchrony, as defined by echocardiography and other imaging modalities. The current viewpoint calls for a more systematic segmental approach for describing the coronary venous anatomy.
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Affiliation(s)
- Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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