Abstract 2886: The Anatomy of the Coronary Venous System: a Major Determinant for Cardiac Resynchronization
Introduction: The implant of a left ventricular lead can be challenging due to anatomical features that may limit the access to the target vein.
Objective: To correlate the anatomy of the venous system in necropsy hearts with the angiogram during the implant of a left ventricular lead.
Method: 35 hearts were studied (56±18y, 56% male) and the findings correlated with those obtained by venous angiogram (LAO, AP) in 135 patients (p) (66±9y, 71%male) to whom an LV lead was implanted.
Results: The weight of the hearts was 455±203g. The ostium of the coronary sinus (OCS) diameter was 11.6±3.9mm (6–18mm). A Tebesian valve (TeV) was found in 24 hearts (80%) implanted at the inferior margin of the ostium, occupying 44±33% of its perimeter and covering 35±32% of the orifice. The TeV covered >80% in 7p (23%). In 14, the TeV exhibited fenestrations (40%). A Vieussen’s valve (ViV) was seen in 25 hearts (71%), at 35±13mm distance from the OCS, being restrictive in 12 (46%). The vein of Marshall (VMa) was identified in 5 hearts (14%) and associated to the ViV in all. In 14 (9%) out of 64 veins with a diameter>2mm, a venous valve at its drainage was seen. These findings were similar to those observed in p studied by angiography. In these, the OCS diameter was 11.6±4.2mm and a TeV was seen in 82p (62%), covering 47±26% of the orifice. Fenestrations were observed in 35p (26%). A prominent ViV was identified in 57p (43%). The VMa was present in 20p (15%), associated to a ViV in 18 (90%). A VeV at the drainage of the target vein was visualized in 25p (19%).
Conclusion: There are features of the coronary venous system that may difficult the implant of an LV lead. These obstacles can be adequately identified by a coronary venous angiography.