Abstract 11143: Anatomy of the Coronary Sinus and the Epicardial Coronary Venous System at Autopsy: A Perspective for Electrophysiologists
Introduction: Cannulation of the coronary sinus (CS) is routinely required for electrophysiological studies and placing left ventricular (LV) leads. Understanding the anatomy of the coronary venous system is essential to facilitate procedural success.
Methods and Results: We examined and made gross measurements on 620 hearts from autopsy (October 1998 to July 2003; mean age 60±23 years, 56% male), of which 96% had a preserved CS for analysis (see table). A Thebesian valve covered the CS ostium in 63%. It covered the posterior aspect of the ostium in all, with extension superiorly in 50%, extension inferiorly in 18%, and circumferential with fenestrations in 3 specimens. Vieussens valve, at the junction of the great cardiac vein with the coronary sinus, was prominent in 8%. A prominent middle cardiac vein valve was present in 5% of hearts. Left atrial venous branches were identified in 93%, and in 41% at least one branch could accommodate a 3-French lead. For LV lead placement, the mid-lateral LV was accessible from the middle cardiac vein (20%), the left posterior vein (92%) or the anterior interventricular vein (86%). In specimens with attached pericardium and left phrenic nerve, the nerve crossed over the mid-lateral LV in 45%.
Implications: Although valves are present in the coronary venous circulation, only rarely can they obstruct venous access. The anatomic orientation of the Thebesian valve favors the catheter to cannulate the CS as it is being withdrawn from the tricuspid annulus on torquing counterclockwise. LV epicardial venous anatomy has variability and redundancy, such that the mid-lateral LV can be accessed through various combinations of epicardial veins.
- © 2011 by American Heart Association, Inc.