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Keiler J, Meinel FG, Ortak J, Weber MA, Wree A, Streckenbach F. Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue-Implications for Cardiac Resynchronization Therapy Leads. Front Cardiovasc Med 2021; 7:611160. [PMID: 33426007 PMCID: PMC7793918 DOI: 10.3389/fcvm.2020.611160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Subvenous epicardial fat tissue (SEAT), which acts as an electrical insulation, and the venous diameter (VD) both constitute histomorphological challenges for optimal application and lead design in cardiac synchronization therapy (CRT). In this study, we characterized the morphology of human coronary veins to improve the technical design of future CRT systems and to optimize the application of CRT leads. We retrospectively analyzed data from cardiac computed tomography (CT) of 53 patients and did studies of 14 human hearts using the postmortem freeze section technique and micro CT. Morphometric parameters (tributary distances, offspring angles, luminal VD, and SEAT thickness) were assessed. The left posterior ventricular vein (VVSP) had a mean proximal VD of 4.0 ± 1.4 mm, the left marginal vein (VMS) of 3.2 ± 1.5 mm and the anterior interventricular vein (VIA) of 3.9 ± 1.3 mm. More distally (5 cm), VDs decreased to 2.4 ± 0.6 mm, 2.3 ± 0.7 mm, and 2.4 ± 0.6 mm, respectively. In their proximal portions (15 mm), veins possessed mean SEAT thicknesses of 3.2 ± 2.4 (VVSP), 3.4 ± 2.4 mm (VMS), and 4.2 ± 2.8 mm (VIA), respectively. More distally (20-70 mm), mean SEAT thicknesses decreased to alternating low levels of 1.3 ± 1.1 mm (VVSP), 1.7 ± 1.1 mm (VMS), and 4.3 ± 2.6 mm (VIA), respectively. In contrast to the VD, SEAT thicknesses alternated along the further distal vein course and did not display a continuous decrease. Besides the CRT responsiveness of different areas of the LV myocardium, SEAT is a relevant electrophysiological factor in CRT, potentially interfering with sensing and pacing. A sufficient VD is crucial for successful CRT lead placement. Measurements revealed a trend toward greater SEAT thickness for the VIA compared to VVSP and VMS, suggesting a superior signal-to-noise-ratio in VVSP and VMS.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Jasmin Ortak
- Rhythmology and Clinical Electrophysiology, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Felix Streckenbach
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany.,Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany
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Evaluation of the anatomical variations of the coronary venous system in patients with coronary artery calcification using 256-slice computed tomography. PLoS One 2020; 15:e0242216. [PMID: 33206718 PMCID: PMC7673525 DOI: 10.1371/journal.pone.0242216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
The factors that determine the anatomical variations of the coronary venous system (CVS) are poorly understood. The objective of this study was to evaluate the anatomical variations of the CVS in patients with coronary artery calcification. 196 patients underwent non-contrast CT and coronary CT angiography using 256-slice CT. All subjects were divided into four groups based on their coronary artery calcium score (CACS): 50 patients with CACS = 0 Agatston unit (AU), 52 patients with CACS = 1–100 AU, 44 patients with CACS = 101–400 AU, and 50 patients with CACS > 400 AU. The presence of the following cardiac veins was evaluated: the coronary sinus (CS), great cardiac vein (GCV), posterior interventricular vein (PIV), posterior vein of the left ventricle (PVLV), left marginal vein (LMV), anterior interventricular vein (AIV), and small cardiac vein (SCV). Vessel diameters were also measured. We found that the CS, GCV, PIV, and AIV were visualized in all patients, whereas the PVLV and LMV were identified in a certain proportion of patients: 98% and 96% in the CACS = 0 AU group, 100% and 78.8% in the CACS = 1–100 AU group, 93.2% and 77.3% in the CACS = 101–400 AU group, and 98% and 78% in the CACS > 400 AU group, respectively. The LMV was less often identified in the last three groups than in the first group (p < 0.05). The frequency of having either one PVLV or LMV was higher in the last three groups than in the first group (p < 0.05). No significant differences in vessel diameters were observed between the groups. It was concluded that patients with coronary artery calcification were less likely to have the LMV, which might hamper the left ventricular lead implantation in cardiac resynchronization therapy.
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Assessment of the Relationship Between the Coronary Venous and Arterial Systems Using 256-Slice Computed Tomography. J Comput Assist Tomogr 2020; 44:1-6. [DOI: 10.1097/rct.0000000000000949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Markstad H, Bakos Z, Ostenfeld E, Geijer M, Carlsson M, Borgquist R. Preoperative CT of cardiac veins for planning left ventricular lead placement in cardiac resynchronization therapy. Acta Radiol 2019; 60:859-865. [PMID: 30304945 DOI: 10.1177/0284185118803796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Hanna Markstad
- Department for Medical Imaging and Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Zoltan Bakos
- Department of Clinical Sciences, Arrhythmia Section, Lund University, Skane University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Department for Medical Imaging and Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Mats Geijer
- Department for Medical Imaging and Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department for Medical Imaging and Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Department of Clinical Sciences, Arrhythmia Section, Lund University, Skane University Hospital, Lund, Sweden
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Catanzaro JN, Makaryus JN, Jadonath R, Makaryus AN. Planning and guidance of cardiac resynchronization therapy-lead implantation by evaluating coronary venous anatomy assessed with multidetector computed tomography. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:43-50. [PMID: 25995655 PMCID: PMC4420495 DOI: 10.4137/cmc.s18762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/12/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We sought to evaluate the utility of multidetector computed tomography (MDCT) in preoperative planning of cardiac resynchronization therapy (CRT) device implantation. BACKGROUND Variation in coronary venous anatomy can affect optimal lead placement and may warrant preimplantation visualization prior to CRT lead placement. METHODS Prospective randomized enrollment of 29 patients (17 males; mean age at implant 66.7 ± 12.8 years) was undertaken. Patients were randomized to preimplantation MDCT (GE® 64-detector Lightspeed, n = 16) or no MDCT. Implantation was planned based on three-dimensional coronary venous reconstruction as visualized in the CT group. Measurement of coronary sinus (CS) angulation, CS ostial (os) diameter, right atrial (RA) width, volume, and height was undertaken prior to implant. Intraoperative CS lead implantation times (introduction, cannulation, and left ventricular [LV] lead positioning), procedure time, fluoroscopy time, and venogram contrast volume were measured to determine if there was a difference between patients who underwent preimplant CT scan and those who did not. RESULTS CS os diameter (mean = 13.8 ± 2.9 cm) was inversely correlated with total fluoroscopy time (r = −0.57, P = .008), and total procedure time, but this correlation was not statistically significant (r = −0.36, P = 0.12). RA width (mean = 52.8 ± 9.9 cm) was associated with a shorter total procedure time (r = −0.44, P = .047) and LV lead positioning time (r = −0.33, P = .012). There were no statistically significant differences between the CT group and the non-CT group with respect to total intraoperative and fluoroscopy times or venogram contrast volumes. Total procedure time was longer in the CT group but the difference was not statistically significant (94 ± 27.2 vs. 74.7 ± 26.6; P = .065). CONCLUSION Noninvasive visualization of the coronary venous anatomy before CRT implantation can be used as a guide for lead placement. While no significant differences were noted between the two groups with respect to intraoperative variables, CS os diameter and RA width inversely correlated to a shorter procedure time and LV lead positioning time, respectively. Further clinical trials regarding the utility of MDCT to visualize coronary venous anatomy prior to CRT implantation for procedural planning and lead placement guidance are warranted.
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Affiliation(s)
- John N Catanzaro
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
| | - John N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
| | - Ram Jadonath
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
| | - Amgad N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA. ; Department of Cardiology, NuHealth, Nassau University Medical Center, East Meadow, NY, USA
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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Sun C, Pan Y, Wang H, Li J, Nie P, Wang X, Ma H, Huo F. Assessment of the coronary venous system using 256-slice computed tomography. PLoS One 2014; 9:e104246. [PMID: 25089900 PMCID: PMC4121327 DOI: 10.1371/journal.pone.0104246] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 07/07/2014] [Indexed: 12/14/2022] Open
Abstract
Purpose To investigate the coronary venous system and its relation to adjacent structures using 256-slice computed tomography (CT). Materials and Methods The study consisted of 102 patients who underwent coronary CT angiography (CTA) using 256-slice CT. For each patient, the coronary venous system and its relation to adjacent structures were evaluated. The appropriate locations and diameters of the posterior interventricular vein (PIV), posterior vein of the left ventricle (PVLV) and the left marginal vein (LMV) were detected. The paired student's t test was used to evaluate the difference between the diameter of the coronary sinus (CS) ostium in anteroposterior direction and that in superoinferior direction. Results The CS, great cardiac vein (GCV), PIV, and anterior interventricular vein (AIV) were visualized in all cases. It was possible to evaluate at least one main vein with adequate caliber and regular course for cardiac resynchronization therapy (CRT) in 96.1% of these cases. The diameter of the CS ostium in superoinferior direction (11.7±2.1 mm) was larger than that in anteroposterior direction (9.0±2.0 mm) (t = 13.511, P<0.05). For the majority of the cases, the CS-GCV was located above the level of the mitral valve annulus (MVA), while the left circumflex coronary artery (LCX) was coursed between the CS-GCV and the MVA. LMV had more intersection with the circumflex or circumflex marginal than PVLV. Conclusion 256-slice CT provides superior noninvasive evaluation of the coronary venous system which has important clinical implications.
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Affiliation(s)
- Chunjuan Sun
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China
- Department of Radiology, Yuhuangding Hospital, Yantai, Shandong, China
| | - Yinghua Pan
- Department of Radiology, Yuhuangding Hospital, Yantai, Shandong, China
| | - Hongbo Wang
- Department of Radiology, Yuhuangding Hospital, Yantai, Shandong, China
| | - Jian Li
- Department of Radiology, Yuhuangding Hospital, Yantai, Shandong, China
| | - Pei Nie
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China
| | - Ximing Wang
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China
- * E-mail: (XW); (HM)
| | - Heng Ma
- Department of Radiology, Yuhuangding Hospital, Yantai, Shandong, China
- * E-mail: (XW); (HM)
| | - Futao Huo
- Department of Radiology, Yuhuangding Hospital, Yantai, Shandong, China
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A detailed assessment of the human coronary venous system using contrast computed tomography of perfusion-fixed specimens. Heart Rhythm 2013; 11:282-8. [PMID: 24144884 DOI: 10.1016/j.hrthm.2013.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Access to the coronary venous system is required for the delivery of several cardiac therapies including cardiac resynchronization therapy, coronary sinus ablation, and coronary drug delivery. Therefore, characterization of the coronary venous anatomy will provide insights to gain improved access to these vessels and subsequently improved therapies. For example, cardiac resynchronization therapy has a 30% nonresponder rate, partially due to suboptimal lead placement within the coronary veins. OBJECTIVE To understand the implications of coronary venous anatomy for the development of devices deployed within these vessels. METHODS We cannulated the coronary sinus of 121 perfusion-fixed human hearts with a venogram balloon catheter and injected contrast into the venous system while obtaining computed tomographic images. For each major coronary vein, distance to the coronary sinus, branching angle, arc length, tortuosity, number of branches, and ostial diameter were assessed from the reconstructed anatomy. RESULTS Twenty-nine percent (35/121) specimens did not have a venous branch overlying the inferolateral side of the heart large enough to fit a 5F pacing lead. No significant differences in anatomy were found between subgroups with varying cardiac medical histories. CONCLUSION The anatomical approach employed in this study has allowed for the development of a unique database of human coronary venous anatomy that can be used for the optimization of design and delivery of cardiac devices.
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Normal anatomy and variants of the venous cardiac system in MDCT coronary angiography. Radiol Med 2013; 118:1149-56. [PMID: 23716280 DOI: 10.1007/s11547-013-0924-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 10/26/2022]
Abstract
Three separate venous systems drain the blood returning from the heart walls. These veins are characterised by remarkable variability in terms of frequency, size and course. The knowledge of cardiac venous anatomy is of primary importance during interventional cardiac procedures that require catheterisation of cardiac veins. Some anatomical variants may hinder or contraindicate access to target veins. Coronary angiography (CA) with multidetector computed tomography (MDCT-CA) and multiplanar reformations (MPR), maximum intensity projection (MIP) and 3D reconstructions provides noninvasive visualisation of normal cardiac veins and anatomical variants. The purpose of this pictorial review is to describe by MDCT-CA the anatomy and main variants of the cardiac venous system.
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Spencer J, Fitch E, Iaizzo PA. Anatomical reconstructions of the human cardiac venous system using contrast-computed tomography of perfusion-fixed specimens. J Vis Exp 2013. [PMID: 23629052 DOI: 10.3791/50258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A detailed understanding of the complexity and relative variability within the human cardiac venous system is crucial for the development of cardiac devices that require access to these vessels. For example, cardiac venous anatomy is known to be one of the key limitations for the proper delivery of cardiac resynchronization therapy (CRT)(1) Therefore, the development of a database of anatomical parameters for human cardiac venous systems can aid in the design of CRT delivery devices to overcome such a limitation. In this research project, the anatomical parameters were obtained from 3D reconstructions of the venous system using contrast-computed tomography (CT) imaging and modeling software (Materialise, Leuven, Belgium). The following parameters were assessed for each vein: arc length, tortuousity, branching angle, distance to the coronary sinus ostium, and vessel diameter. CRT is a potential treatment for patients with electromechanical dyssynchrony. Approximately 10-20% of heart failure patients may benefit from CRT(2). Electromechanical dyssynchrony implies that parts of the myocardium activate and contract earlier or later than the normal conduction pathway of the heart. In CRT, dyssynchronous areas of the myocardium are treated with electrical stimulation. CRT pacing typically involves pacing leads that stimulate the right atrium (RA), right ventricle (RV), and left ventricle (LV) to produce more resynchronized rhythms. The LV lead is typically implanted within a cardiac vein, with the aim to overlay it within the site of latest myocardial activation. We believe that the models obtained and the analyses thereof will promote the anatomical education for patients, students, clinicians, and medical device designers. The methodologies employed here can also be utilized to study other anatomical features of our human heart specimens, such as the coronary arteries. To further encourage the educational value of this research, we have shared the venous models on our free access website: www.vhlab.umn.edu/atlas.
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Spencer JH, Anderson SE, Iaizzo PA. Human coronary venous anatomy: implications for interventions. J Cardiovasc Transl Res 2013; 6:208-17. [PMID: 23307201 DOI: 10.1007/s12265-012-9443-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 12/19/2012] [Indexed: 11/29/2022]
Abstract
The coronary venous system is a highly variable network of veins that drain the deoxygenated blood from the myocardium. The system is made up of the greater cardiac system, which carries the majority of the deoxygenated blood to the right atrium, and the smaller cardiac system, which drains the blood directly into the heart chambers. The coronary veins are currently being used for several biomedical applications, including but not limited to cardiac resynchronization therapy, ablation therapy, defibrillation, perfusion therapy, and annuloplasty. Knowledge of the details of the coronary venous anatomy is essential for optimal development and delivery of treatments using this vasculature. This article is part of a JCTR special issue on Cardiac Anatomy.
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Affiliation(s)
- Julianne H Spencer
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA.
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Ohta Y, Fujii S, Kakite S, Mizuta E, Hashimoto M, Kaminou T, Ogawa T. Evaluation of the Optimal Image Reconstruction Interval for Noninvasive Coronary 64-Slice Computed Tomography Venography. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojrad.2013.32010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Roule V, Chazalviel L, Young AR, Lebon A, Beaudouin V, Agostini D, Milliez P, Dacher JN, Manrique A. Prospective versus retrospective ECG-gating for 64-detector computed tomography of the coronary venous system in pigs. Arch Cardiovasc Dis 2012; 105:468-77. [PMID: 23062478 DOI: 10.1016/j.acvd.2012.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/21/2012] [Accepted: 05/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multidetector computed tomography (MDCT) provides a non-invasive anatomic description of the coronary veins that may be useful in patients candidates to cardiac resynchronization. Prospective gating reduces radiation exposure but its impact on image quality is unknown is this setting. AIMS This study compared image quality and reliability of MDCT angiography of the coronary veins between prospective and retrospective gating. METHODS Seven anaesthetized pigs underwent 64-detector row MDCT with prospective and retrospective ECG-gating. MDCT scans were evaluated for visibility of the veins, estimated radiation dose and vein characteristics. Inter- and intra-observer reproducibility was calculated. RESULTS Visibility grades of all veins were significantly decreased in prospective (0.82 ± 0.6) compared to retrospective gating (1.68 ± 0.9; P<0.001), the lateral vein being missed in two cases when using prospective vs. retrospective gating. The maximal vein length was significantly increased when using retrospective gating (P=0.015). Inter-observer but not intra-observer reproducibility was dependent on the gating technique for the maximal length and contrast-to-noise ratio (P=0.003 for both). Heart rate was 82 ± 13 bpm and 86 ± 11 bpm during retrospective and prospective ECG-gating (P=ns) despite full dose of atenolol titration. CONCLUSION Retrospective gating seems to be superior to prospective gating MDCT to describe the coronary venous system but the conclusions of our study should be confined to high heart rate condition.
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Affiliation(s)
- Vincent Roule
- GIP Cyceron, Biomedical Imaging Platform, boulevard Henri-Becquerel, BP 5229, 14074 Caen cedex 5, France.
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Malagò R, Pezzato A, Barbiani C, Sala G, Zamboni GA, Tavella D, Mucelli RP. Non invasive cardiac vein mapping: role of multislice CT coronary angiography. Eur J Radiol 2012; 81:3262-9. [PMID: 22480417 DOI: 10.1016/j.ejrad.2012.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 03/01/2012] [Accepted: 03/05/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE Coronary venous anatomy is of primary importance when implanting a cardiac resynchronization therapy device, besides, the coronary sinus can be differently enlarged depending on chronic heart failure. The aim of this study is to evaluate the usefulness of Coronary CTA in describing the coronary venous tree and in particular the coronary sinus and detecting main venous system variants. MATERIALS AND METHODS 301 consecutive patients (196 ♂, mean age 63.74 years) studied for coronary artery disease with 64 slice Coronary CTA were retrospectively examined. The acquisition protocol was the standard acquisition one used for coronary artery evaluation but the cardiac venous system were visualized. The cardiac venous system was depicted using 3D, MPR, cMPR and MIP post-processing reconstructions on an off-line workstation. For each patient image quality, presence and caliber of the coronary sinus (CS), great cardiac vein (GCV), middle vein (MV), anterior interventricular vein (AIV), lateral cardiac vein (LCV), posterior cardiac vein (PCV), small cardiac vein (SCV) and presence of variant of the normal anatomy were examined and recorded. RESULTS CS, GCV, MV and AIV were visualized in 100% of the cases. The LCV was visualized in 255/301 (84%) patients, the PCV in 248/301 (83%) patients and the SCV in 69/301 (23%) patients. Mean diameter of the CS was 8.7 mm in 276/301 (91.7%) patients without chronic heart failure and 9.93 mm in 25/301 (8.3%) patients with chronic heart failure. CONCLUSIONS Coronary CTA allows non invasive mapping of the cardiac venous system and may represent a useful presurgical tool for biventricular pacemaker devices implantation.
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Affiliation(s)
- Roberto Malagò
- Radiology Department, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona, Italy.
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Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med 2012; 117:901-38. [PMID: 22466874 DOI: 10.1007/s11547-012-0814-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/14/2011] [Indexed: 12/13/2022]
Abstract
Cardiac computed tomography (CCT) has grown as a useful means in different clinical contexts. Technological development has progressively extended the indications for CCT while reducing the required radiation dose. Even today there is little documentation from the main international scientific societies describing the proper use and clinical indications of CCT; in particular, there are no complete guidelines. This document reflects the position of the Working Group of the Cardiac Radiology Section of the Italian Society of Radiology concerning the indications for CCT.
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Doganay S, Karaman A, Gündogdu F, Duran C, Yalcin A, Kantarci M. Usefulness of multidetector computed tomography coronary venous angiography examination before cardiac resynchronization therapy. Jpn J Radiol 2011; 29:342-7. [DOI: 10.1007/s11604-011-0565-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/16/2011] [Indexed: 12/01/2022]
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Cubuk R, Aydin A, Tasali N, Yilmazer S, Celik L, Dagdeviren B, Guney S. Non-invasive evaluation of the coronary venous system in patients with chronic systolic heart failure by 64-detector computed tomography. Acta Radiol 2011; 52:372-7. [PMID: 21498314 DOI: 10.1258/ar.2011.100241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Imaging coronary venous systems to guide transcatheter cardiac interventions are becoming increasingly important, particularly in heart failure patients who are selected for cardiac resynchronization therapy (CRT). Failure of left ventricular (LV) lead placement during the procedure has been attributed to the inability to insert catheters into the coronary sinus and the lack of suitable side branches. PURPOSE To comparatively assess the value of a 64-detector MDCT examination in visualizing the cardiac veins and evaluating the morphological characteristics of the coronary venous system in patients with and without chronic systolic heart failure (SHF). MATERIAL AND METHODS A 64-detector MDCT examination of the heart was performed in 26 consecutive patients (five women, 21 men; mean age 57.80 ± 12.05 years; range 27-81 years) with chronic SHF. The morphological characteristics of the coronary venous system, such as the diameter, the distances between the venous tributaries, the angle and the tortuosity, were evaluated. The group was compared with a subgroup of 52 subjects without SHF (LV ejection fraction >40%) matched for age, sex, and the risk factors for coronary artery disease. RESULTS The coronary sinus (CS), great cardiac vein (GCV), anterior interventricular vein (AIV), and posterior interventricular vein (PIV) were visualized in all 78 individuals. The posterior vein of the left ventricle (PVLV) (63/78), left marginal vein (LMV) (72/78), and the small cardiac vein (SCV) (50/78) were visualized in SHF and control patients (p = NS). The lengths between venous tributaries were higher (p > 0.05) and more dilated (P < 0.001 for CS, GCV, AIV, PVLV, LMV; p = 0.001 for PIV) in the cases with SHF compared with the control population. The angle between the CS-GCV axis and the venous branches was wider (p = 0.02 for LMV and PIV, p = 0.001 for PVLV) and did not have any correlation with the LV diameter in cases with SHF. There was no difference between the SHF and control groups in terms of the tortuosity of PVLV and LMV (p = NS). CONCLUSION The study demonstrated an increase in the diameters, lengths, and angulations with the CS-GCV axis of the coronary veins in cases with SHF. A 64-detector MDCT is a feasible tool for non-invasive evaluation of the coronary venous system and may provide considerable information regarding numbers and morphology of coronary veins before percutaneous transcatheter cardiac therapy.
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Affiliation(s)
| | - Alper Aydin
- Department of Cardiology, Maltepe University School of Medicine, Maltepe, İstanbul, Turkey
| | | | - Serdar Yilmazer
- Department of Cardiology, Maltepe University School of Medicine, Maltepe, İstanbul, Turkey
| | | | - Bahadir Dagdeviren
- Department of Cardiology, Maltepe University School of Medicine, Maltepe, İstanbul, Turkey
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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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Imaging of cardiac venous system in patients with dilated cardiomyopathy by 64-slice computed tomography: Comparison between non-ischemic and ischemic etiology. Int J Cardiol 2010; 144:340-3. [DOI: 10.1016/j.ijcard.2009.03.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 03/04/2009] [Indexed: 11/19/2022]
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20
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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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21
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Improvement in the quality of the cardiac vein images by optimizing the scan protocol of multidetector-row computed tomography. Heart Vessels 2009; 24:434-9. [DOI: 10.1007/s00380-008-1142-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 12/19/2008] [Indexed: 10/20/2022]
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22
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MDCT evaluation of the cardiac venous system. Radiol Med 2009; 114:837-51. [PMID: 19568701 DOI: 10.1007/s11547-009-0417-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 12/12/2008] [Indexed: 01/17/2023]
Abstract
PURPOSE This study was undertaken to evaluate the usefulness of electrocardiographically (ECG)-gated multidetector-row computed tomography (MDCT) for the assessment of the coronary venous system and detection of its anatomical variants, in order to identify those suitable for lead placement in cardiac resynchronisation therapy (CRT). MATERIALS AND METHODS We retrospectively examined the coronary MDCT studies of 89 patients (73 males, 16 females, average age 62.5 years, range 31-79) referred for suspected coronary artery disease. The cardiac venous system was assessed in all patients using three-dimensional (3D) postprocessing on a dedicated Vitrea workstation (five patients were excluded from the analysis). RESULTS The coronary sinus, the great cardiac vein, the anterior interventricular vein and the middle cardiac vein were visualised in all cases. The lateral cardiac vein was visualised in 56/84 patients (67%) and the posterior cardiac vein in 63/84 patients (75%), never both missing. Along the postero-lateral wall of the left ventricle, only one branch was present in 44 cases, two branches in 21 cases and three or more branches in 19/84 cases (22%). Evaluation of the maximum diameter revealed that the lateral vein was dominant over the posterior vein in 20/40 cases. The small cardiac vein was visualised in 11/84 cases. CONCLUSIONS MDCT provides good depiction of the cardiac venous system, enabling the study of the vessel course and the identification of anatomical variants. Hence, this imaging technique could be proposed for the preoperative planning of CRT in selected patients.
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23
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Mlynarski R, Sosnowski M, Wlodyka A, Kargul W, Tendera M. A user-friendly method of cardiac venous system visualization in 64-slice computed tomography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:323-9. [PMID: 19272061 DOI: 10.1111/j.1540-8159.2008.02239.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previsualization of the cardiac venous system is very important for some techniques, for example, cardiac resynchronization therapy (CRT). The aim of this study was to propose a new, user-friendly method of cardiac venous system visualization in 64-slice computed tomography (CT). METHODS In 112 patients (66 M) aged 58 +/- 11 standard deviation, a 64-slice CT with a retrospective electrocardiogram gating was performed due to a suspicion of ischemic heart disease. Special attention was paid to the requirements for image reconstruction useful for CRT. RESULTS In 74% of the patients, it was possible to obtain similar images to those during the CRT implantation procedure within anterior-posterior, left anterior oblique, and right anterior oblique views. The coronary sinus was clearly visible in all cases, the ostium measured 12.9 +/- 5.9 mm, and the angle of entrance 99 +/- 12 degrees. In all patients it was possible to demonstrate more than one vein; in 95%, at least one vein was clearly visible in the target area. Among the target veins, the posterolateral vein was visible most frequently (78%) in the cases as well as the lateral vein (78%). CONCLUSION The proposed scheme in 64-slice computed tomography enables images to be generated similar to the intraoperative fluoroscopy, which can be useful in techniques where previsualization of the cardiac venous system is recommended.
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Affiliation(s)
- Rafal Mlynarski
- Department of Electrocardiology, Medical University of Silesia, ul Ziolowa 45/47, Katowice, Poland.
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24
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Optimal image reconstruction intervals for noninvasive visualization of the cardiac venous system with a 64-slice computed tomography. Int J Cardiovasc Imaging 2009; 25:635-41. [PMID: 19415522 DOI: 10.1007/s10554-009-9463-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
Abstract
The purpose of the study was to evaluate in which phase of the cardiac cycle visualization of the cardiac veins could achieve the highest possible quality. In 138 patients (aged 56.6 +/- 10.6; 58F) with a suspicion of CAD, a 64-slice CT (Toshiba Aquilion) was performed. In each case ten 3D volume rendering reconstructions were created from 0 to 90% R-R intervals (step 10%) using a 0.5 mm slice thickness (reconstructions 2.0 mm). An arbitrary score of the quality of images was introduced. In 82 (59.4%) patients optimal image quality was noted at the 40% phase, in 28 (20.3%) at the 30% phase and finally in 14 (10.1%) at the 50% phase. These 3 phases (30/40/50%) were the best option for 124 (89.8% of all) patients. In the rest of the patients the best visualization was obtained in other phases as follows: 60 and 80% for 4 patients (2.9%); 70% for 3 patients (2.3%) and at the 0, 10, 20% one patient at each phase (0.7%). The optimal phases of the cardiac cycle for the visualization of the cardiac venous system are 30 or 40%. Less frequently, an alternative could be the 50% phase.
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Hara T, Yamashiro K, Okajima K, Hayashi T, Kajiya T. Posterior Shift of the Anterior Papillary Muscle in Patients With Heart Failure A Potential Role in the Effect of Cardiac Resynchronization Therapy. Int Heart J 2009; 50:773-82. [DOI: 10.1536/ihj.50.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tetsuya Hara
- Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School
- Department of Cardiology, Himeji Cardiovascular Center
| | - Kohei Yamashiro
- Department of Cardiology, Himeji Cardiovascular Center
- Department of Cardiology, Toyohashi Heart Center
| | | | | | - Teishi Kajiya
- Department of Cardiology, Himeji Cardiovascular Center
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26
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Truong QA, Hoffmann U, Singh JP. Potential uses of computed tomography for management of heart failure patients with dyssynchrony. Crit Pathw Cardiol 2008; 7:185-90. [PMID: 18791407 PMCID: PMC3733254 DOI: 10.1097/hpc.0b013e318178eaa5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Cardiac resynchronization therapy has become an integral part in the step-care approach to manage patients with heart failure. Cardiac imaging remains central to appropriate patient selection and optimal left ventricular lead placement, both of which are important determinants of response to cardiac resynchronization therapy. One of the biggest limitations with current imaging modalities is the inability of a single technique to address each, the anatomic (venous anatomy), mechanical (dyssynchrony), and structural (extent of scar location) issues accompanying cardiomyopathy. We present here the potential concept of using cardiac computed tomography as a single modality to acquire functional and anatomic information, and also to show the possibility of integrating this with real time fluoroscopy.
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Affiliation(s)
- Quynh A. Truong
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jagmeet P. Singh
- Cardiac Arrhythmia Service, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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27
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DURAY GABORZ, HOHNLOSER STEFANH, ISRAEL CARSTENW. Coronary Sinus Side Branches for Cardiac Resynchronization Therapy: Prospective Evaluation of Availability, Implant Success, and Procedural Determinants. J Cardiovasc Electrophysiol 2008; 19:489-94. [DOI: 10.1111/j.1540-8167.2007.01096.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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28
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Prevalence and characterization of pulmonary vein variants in patients with atrial fibrillation determined using 3-dimensional computed tomography. Am J Cardiol 2008; 101:1638-42. [PMID: 18489943 DOI: 10.1016/j.amjcard.2008.01.053] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 01/21/2008] [Accepted: 01/21/2008] [Indexed: 11/21/2022]
Abstract
Although several branching patterns of pulmonary veins (PVs) were reported, their prevalence and characterization were not sufficiently clarified. Multislice computed tomography was performed in 428 patients who underwent catheter ablation for drug-refractory atrial fibrillation. Size and branching pattern of PVs were analyzed. A typical pattern of 4 PVs with 4 separate ostia was found in 326 patients (76%). However, a common PV trunk, defined as a PV with coalescence of superior and inferior PVs > or =1.5 cm proximal to the junction with the left atrium, was found on the left side in 34 patients (8%) and right side in 3 patients (0.76%). A discrete middle PV was found on the right side in 54 patients (13%) and left side in 9 patients (2%). A right top PV, defined as an anomalous insertion of a branch of the right superior PV into the left atrial body, was also found in 16 patients (4%). In conclusion, 24% of our patients with atrial fibrillation had PV anomalies and 3% had coexistence of 2 PV variants, indicating that PV variants are not rare.
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Conca C, Faletra F, Chioncel O, Sorgente A, Pasotti E, Pedrazzini G, Moccetti T, Auricchio A. Coronary Sinus Visualization by 3-dimensional Real-time Echocardiography. J Am Soc Echocardiogr 2008; 21:371-6. [PMID: 17628405 DOI: 10.1016/j.echo.2007.05.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Real-time 3-dimensional echocardiography (RT3DE) to visualize the coronary sinus (CS) was compared with multislice cardiac tomography (MSCT). METHODS In all, 37 consecutive patients undergoing MSCT received RT3DE a few hours later. Group A (n = 22) had normal left ventricular dimension/function, whereas group B (n = 15) had heart failure. RESULTS The CS could be visualized in both groups (91% and 93%) with a significantly larger diameter in B. Systolic CS diameter was always larger than diastolic, but patients with heart failure showed significantly less difference (7.6% +/- 4.2% vs 12.2% +/- 6.1%, P < .05). When systolic and diastolic measurements were possible, MSCT and RT3DE agreed (Lin R = -0.09 [95% confidence interval 0.73-0.93]) but less so from the proximal to mid/distal segments (Lin R 0.90, 0.61, 0.41, respectively). Observers learned the procedure in approximately 5 minutes. CONCLUSION The CS can be visualized and quantitatively assessed by RT3DE in an easily learned procedure that agrees with MSCT results, especially in patients with heart failure.
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Affiliation(s)
- Cristina Conca
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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30
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Yamada M, Jinzaki M, Kuribayashi S, Sato K, Tanami Y, Fukumoto K, Tanimoto K, Sato T, Soejima K, Ogawa S. Novel post-processing image for the visualization of the coronary sinus by multidetector-row computed tomography before cardiac resynchronization therapy: edge-enhanced image. Circ J 2008; 72:487-8. [PMID: 18296851 DOI: 10.1253/circj.72.487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Before performing cardiac resynchronization therapy (CRT), it is useful to visualize the position of the coronary sinus (CS) orifice where the CS lead is inserted. METHODS AND RESULTS A raysum image was created in which the outermost 1-voxel layer of the right atrium (RA) and CS was extracted. This image enabled visualization of the positional relationship between the RA and CS ostium using the same geometry as retrograde CS venography. CONCLUSION New post-processing imaging of the CS orifice will make the procedure of CRT safer.
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Affiliation(s)
- Minoru Yamada
- Cardiovascular Imaging Laboratory in Research Park, Keio University School of Medicine, Tokyo, Japan.
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31
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Hemminger EJ, Girsky MJ, Budoff MJ. Applications of computed tomography in clinical cardiac electrophysiology. J Cardiovasc Comput Tomogr 2007; 1:131-42. [DOI: 10.1016/j.jcct.2007.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Revised: 08/09/2007] [Accepted: 09/12/2007] [Indexed: 11/25/2022]
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Auricchio A, Sorgente A, Singh JP, Faletra F, Conca C, Pedrazzini GB, Pasotti E, Siclari F, Moccetti T. Role of multislice computed tomography for preprocedural evaluation before revision of a chronically implanted transvenous left ventricular lead. Am J Cardiol 2007; 100:1566-70. [PMID: 17996521 DOI: 10.1016/j.amjcard.2007.06.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 06/14/2007] [Accepted: 06/14/2007] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to determine the feasibility of multislice computed tomography (MSCT) to assess the coronary sinus (CS) and its tributaries in patients who are undergoing cardiac resynchronization therapy and need a left ventricular (LV) lead revision. Preprocedural imaging modality, which may enable delineation of the cardiac venous anatomy in patients who need LV lead replacement, has not yet been evaluated. Ten patients with heart failure with previously implanted cardiac resynchronization therapy devices, who presented with worsening heart failure, were studied with MSCT and tissue Doppler imaging echocardiography before LV lead replacement. MSCT was performed to evaluate patency of the CS and coronary veins, and tissue Doppler imaging echocardiography assessed the region and the magnitude of mechanical dyssynchrony. An excellent concordance in the vein diameter, location, and status between MSCT and angiography was found. Apart from the need to perform a venoplasty in 1 patient and an unsuccessful lead explantation in another patient, all other anatomic issues were correctly predicted by MSCT. CS or vein occlusion were present in 4 patients, and in 3 of them surgical LV lead replacement was performed. Identification of a patent venous system enabling successful transvenous lead implantation was possible in 2 patients. Direct visualization of the proximity of the target vein to the phrenic nerve and the diaphragm guided lead selection and position in 4 patients. In conclusion, MSCT may be used to delineate the coronary venous anatomy in patients in whom LV lead replacement is needed to help strategize whether a transvenous or transthoracic approach may be preferred for LV lead revision.
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Affiliation(s)
- Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
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Matsumoto Y, Krishnan S, Fowler SJ, Saremi F, Kondo T, Ahsan C, Narula J, Gurudevan S. Detection of phrenic nerves and their relation to cardiac anatomy using 64-slice multidetector computed tomography. Am J Cardiol 2007; 100:133-7. [PMID: 17599455 DOI: 10.1016/j.amjcard.2007.01.072] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 01/29/2007] [Accepted: 01/29/2007] [Indexed: 11/29/2022]
Abstract
The improved temporal and spatial resolution allowed by multidetector computed tomography (MDCT) has facilitated the noninvasive assessment of cardiac anatomy before transcatheter electrophysiologic procedures. Clarification of spatial relations of phrenic nerves and key cardiac structures is important to decrease potential complications. The purpose of this study was to reconstruct the course of the right and left phrenic pericardiophrenic bundles and their relations to cardiac structures using 64-slice MDCT. One hundred six consecutive subjects (age 61 +/- 13 years; 39% women) who underwent self-referred coronary computed tomographic angiography using 64-slice MDCT underwent retrospective assessment of the phrenic nerves contained within the pericardiophrenic bundles. The course of the nerves was outlined in relation to the left atrial appendage, coronary sinus, and cardiac veins. The ability to individually detect the left and right phrenic nerves, as well as the frequency of direct contact between the left phrenic nerve and cardiac veins, was recorded. The left phrenic nerve was identified in 78 of 106 patients (74%). It crossed the left atrial appendage (n = 72, 91%), great cardiac vein (n = 63, 80%), posterior vein of the left ventricle (n = 39, 49%), posterior interventricular vein (n = 8, 10%), and anterior interventricular vein (n = 7, 9%). Mean Hounsfield units (HUs) of the left phrenic nerve was 81 +/- 25. The right phrenic nerve was identified in 50 of 106 patients (47%). Mean HUs of the right phrenic nerve were 94 +/- 26. In conclusion, cardiac imaging using 64-slice MDCT enabled adequate detection of the left and right phrenic nerves in relation to cardiac anatomy. In the setting of electrophysiologic interventions, MDCT before a procedure may elucidate anatomic relationships and help minimize inadvertent complications.
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Affiliation(s)
- Yuji Matsumoto
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
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Kaseno K, Tada H, Tanaka S, Goto K, Yokokawa M, Hiramatsu S, Naito S, Oshima S, Taniguchi K. Successful Catheter Ablation of Left Ventricular Epicardial Tachycardia Originating From the Great Cardiac Vein A Case Report and Review of the Literature. Circ J 2007; 71:1983-8. [DOI: 10.1253/circj.71.1983] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shinichi Tanaka
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Miki Yokokawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shigeru Oshima
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
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Wijetunga M, Cuoco F, Ravi ND, Fuisz A, Strickberger SA. Characterization of the coronary sinus ostium by cardiac magnetic resonance imaging. Am J Cardiol 2006; 98:1400-2. [PMID: 17134638 DOI: 10.1016/j.amjcard.2006.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 06/12/2006] [Accepted: 06/12/2006] [Indexed: 11/26/2022]
Abstract
The diameter and the angle of the coronary sinus (CS) ostium was analyzed in 101 patients who underwent cardiac magnetic resonance imaging and had left ventricular ejection fractions < or =0.35 (n = 40) or > or =0.65 (n = 61). The angle of the CS ostium in patients with LVEFs < or =0.35 was less acute than in patients with LVEFs > or =0.65 (73 degrees +/- 12 degrees vs 65 degrees +/- 10 degrees, p <0.01). There was no statistically significant difference in the diameter of the CS ostium in patients with LVEFs < or =0.35 compared with those with LVEFs > or =0.65 (8 +/- 3 vs 8 +/- 2 mm, p = 0.5). The diameter and the angle of the CS ostium were not different when analyzed on the basis of the duration of the QRS complex, left atrial dimension, or left ventricular end-diastolic dimension. In conclusion, on the basis of cardiac magnetic resonance imaging data, the angle of the CS is less acute in patients with LVEFs < or =0.35 than in those with LVEFs > or =0.65.
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36
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Goitein O, Lacomis JM, Gorcsan J, Schwartzman D. Left ventricular pacing lead implantation: potential utility of multimodal image integration. Heart Rhythm 2006; 3:91-4. [PMID: 16399062 DOI: 10.1016/j.hrthm.2005.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2005] [Accepted: 10/02/2005] [Indexed: 11/19/2022]
Affiliation(s)
- Orly Goitein
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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37
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Yamada M, Jinzaki M, Kuribayashi S, Sato K, Tanami Y, Yun S, Sasaki K. Evaluation of coronary artery lumen diameter with 16-slice multidetector-row computed tomography. Circ J 2005; 69:1230-2. [PMID: 16195622 DOI: 10.1253/circj.69.1230] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND When using 16-slice multidetector-row computed tomography (MDCT) to detect coronary artery stenosis, coronary arteries measuring 1.5 mm or larger in lumen diameter are usually evaluated. The purpose of this study was to investigate the frequency of the visualized lumen in each coronary artery segment measuring more than 1.5 mm in diameter. METHODS AND RESULTS Electrocardiographic-gated 16-slice MDCT was used to scan 20 patients after administration of nitroglycerin. The luminal diameter of each coronary artery segment was measured on cross-sectional images using a caliper method. The frequency of the visualized lumen of each coronary artery segment measuring larger than 1.5 mm in diameter was as follows: #1: 100%, #2: 100%, #3: 100%, #4PD: 85%, #4AV: 80%, #5: 100%, #6: 100%, #7: 100%, #8: 90%, #9: 85%, #10: 40%, #11: 100%, #12: 65%, #13: 100%, #14: 80%. Averaged lumen diameter+/-standard deviation (mm) larger than 1.5 mm in all patients was calculated as follows: #1: 3.8+/-0.70, #2: 3.5+/-0.69, #3: 3.2+/-0.82, #5: 4.2+/-1.04, #6: 3.4 +/-0.79, #7: 2.9+/-0.62, #11: 2.9+/-0.69, #13: 2.6+/-0.57. CONCLUSION Luminal diameter larger than 1.5 mm of each coronary artery segment can be assessed in most cases by 16-slice MDCT.
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Affiliation(s)
- Minoru Yamada
- Cardiovascular Imaging Laboratory in Research Park, Keio University School of Medicine. Tokyo, Japan.
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