Abstract 3187: MSCT Coronary Venous Anatomy is Comparable to Direct Angiographic Venous Anatomy in Identifying Suitable Coronary Veins for Cardiac Resynchronization Therapy
Background: Cardiac Resynchronization Therapy (CRT) is being used more often for refractory heart failure. Optimal left ventricular lead placement is key to good outcomes. Advancements in multislice computed tomography (MSCT) has allowed visualization of the 3-dimensional coronary venous anatomy. We sought to validate MSCT venous anatomic findings with fluoroscopic venous angiography for the purpose of locating and selecting suitable coronary veins for CRT lead placement. Method: Twelve heart failure patients underwent both 16/40/64-row cardiac MSCT (Philips Medical Brilliance CT) and digital coronary venogram prior to CRT implantation. Curved multiplanar reconstructed images from MSCT and cine venograms were used for identifying and measuring coronary veins.
Results: A total of 33 out of 37 (89%) coronary veins fluoroscopically identified as possible targets were seen on MSCT. The coronary vein actually used for lead placement was seen on all 12 patients. The table⇓ lists the number of veins MSCT identified compared to venogram and the corresponding ostial diameters. The average fluoroscopic diameter of the 4 veins not seen by MSCT was 1.95±0.55mm. MSCT identified one additional vein, which was not seen on the venogram. Graphically, the direction and course of the coronary veins between the two methods were similar.
Conclusions: Coronary venous anatomy derived from MSCT is comparable to direct coronary venogram in locating potential Coronary Sinus lead placement targets for CRT. By knowing the coronary venous anatomy prior to CRT implantation, it may lead to decreased procedure time, fluoroscopy time, and contrast dye use.