Background The knowledge about the anatomy of cardiac veins (CV) is important for several trans-sinus cardiologic procedures, such as cardiac resynchronization therapy (CRT) and catheter ablation inside coronary sinus (CS). The purposes of this study were to evaluate the anatomy of CS and CV, and their relationship with coronary artery branches in Korean people who underwent coronary angiography (CAG).
Methods and Results We evaluated CV anatomy and CS contractility with hepatic phase of CAG in 78 patients (male 55.1%, 61.0짹12.3 years old). Coronary artery disease was underlying diseases in 48.7% and left ventricular (LV) dysfunction (EF ���40%) was accompanied in 18.3%. CAG was assessed at left anterior oblique (LAO) 60째 and right anterior oblique (RAO) 30째 views. CS was defined to have contractility when its diameter changes more than 50% during systolic phase. In case with left or balanced dominant coronary artery system (19.2%), the distance between posterior descending coronary artery (PDA) and middle cardiac vein (MCV) was measured. Results: 1) The mean number of postero-lateral CV (PLCV) or lateral CV (LCV) was 1.10짹0.71, and 31.3 % of them were acutely angulated. The mean number of CVs easily accessible or appropriate for CRT (postero-lateral or lateral territory of the LV, diameter > 2mm, and no acute angulation in LAO or RAO view) was 0.91짹0.63. These easily accessible CV for CRT could not be found in 14.1% of patients. 2) The mean diameters of CS, MCV, PLCV, and LCV were 7.6짹2.4 mm, 3.5짹0.1 mm, 3.3짹0.9 mm, and 2.7짹0.9 mm, respectively and CS contraction was observed in 23.1%. Although CS diameter was correlated with left atrial size (r=0.311, p=0.02), CS diameter and contractility had no significant association with left ventricular systolic or diastolic function. 3) PDA ran the proximity (4.1짹5.3 mm) of MCV within 1 cm from the branching point.
Conclusion Most of the patient (85.9%) has the CV appropriate for the engagement of the catheters or electrodes, and MCV exists close to PDA. Anatomical information of CV and CS could be obtained from delayed phase of CAG when considers CRT or catheter ablation