ANGIOGRAPHIC ANATOMY OF THE CORONARY SINUS AND ITS TRIBUTARIES

Permanent left ventricular pacing has been shown to imporve the hemody namic and clinical status of patients with severe heart failure. To pa ce the left ventricle, the electrode is implanted in tributaries of th e coronary sinus (CS). However, the anatomy of cardiac veins with this purpose in mind has not been described in detail. Methods: One hundre d consecutive patients admitted for coronary angiography had a simulta neous coronary venography performed after the injection of 8 to 10 mi of contrast material into the left coronary artery. Cardiac veins were analyzed in antero-posterior, left anterior oblique 60 degrees and ri ght anterior oblique 30 degrees views by three different observers. Th e number, dimension, angulation, and position of the coronary sinus an d of its tributaries were studied. Results: Two veins are consistently present: the middle cardiac vein (mean diameter 2.62 +/- 1.26 mm) and the great cardiac vein (mean diameter 3.55 +/- 1.24 mm). The left pos terior vein(s) (LPV) (mean diameter 2.25 +/- 1.2 mm) is (are) variable in number (ranging from 0 to 3), size, and angulation. The absence of LPV limits the ability to pace the left ventricle endovenously. The d iameter of the vein (< 2 mm) and ifs angulation may also complicate th e insertion of the lead. Conclusion: Angiographic analysis of dimensio ns, tortuosity, number, and angulation of venous tributaries of the CS seems to allow the insertion of commercially available pacing leads i n approximately 85% of cases. An increase in this percentage hinges on the development of new, dedicated leads.