The valve of vieussens: An important cause of difficulty in advancing catheters into the cardiac veins

Catheterization of Cardiac Veins. Introduction: The coronary sinus and card iac veins are useful conduits for the passage of electrode catheters for ma pping the origin of cardiac arrhythmias. However, sometimes it is difficult to advance catheters an adequate distance into the cardiac veins, The aim of this study was to determine the reasons for this. Methods and Results: In 50 cadaveric hearts, a deflectable 7-French electro de catheter was passed from the right atrium into the coronary sinus and ad vanced to the anterior interventricular portion of the great cardiac vein ( GCV). Causes of obstruction were determined. The catheter was obstructed by the valve of Vieussens in 23 of 50 hearts (46%). Once the valve was negoti ated, obstruction was caused by an acute bend in the GCV in 28 of 50 hearts (56%). Clinical studies were undertaken in 10 patients in whom electrode c atheters could not be advanced as far as required. Using contrast renograph y, the most frequent cause of obstruction was determined to be the valve of Vieussens in 8 of 10 eases (80%). An acute bend in the GCV caused obstruct ion in 2 cases (20%). Conclusions: The valve of Vieussens is a frequent cause of obstruction to p assage of a catheter in postmortem and in vivo studies. tin acute bend in t he vein, with or without lodgment in a tributary, is the other common cause , In adults, venous luminal diameter is not a cause of obstruction to the p assage of a 7-french catheter in the coronary sinus or proximal GCV.