Noninvasive visualization of the cardiac venous system using multislice computed tomography
Monique R.M. Jongbloed, MD*,
Hildo J. Lamb, MD, PhD ,
Jeroen J. Bax, MD, PhD*,*,
Joanne D. Schuijf, MSc*,
Albert de Roos, MD, PhD,
Ernst E. van der Wall, MD, PhD* and
Martin J. Schalij, MD, PhD*
* Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Figure 1 The cardiac venous system. (A) The border of the coronary sinus (CS) is marked by the vein of Marshall (VM). The CS continues in the great cardiac vein (GCV), which continues anteriorly in the anterior interventricular vein (AIV). As seen from the right atrium (RA), the first tributary of the CS is the posterior interventricular vein (PIV). The next tributaries are the posterior vein of the left ventricle (PVLV) and left marginal vein (LMV). (B) Left = variant 1; middle = variant 2; right = variant 3. See text for explanation. (C) Left = the CS ostium measured in the anteroposterior direction; transverse plane; right = the CS ostium in superoinferior direction; coronal plane. (D) Measurement of the distances between the different tributaries of the cardiac venous drainage system. Ant = anterior; AP = pulmonary artery; Ao = aorta; LA = left atrium; LV = left ventricle; RV = right ventricle.
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Figure 2 (A) Variant 1. Left = volume-rendered reconstruction. The CS, PIV, and small cardiac vein (SCV) are continuous at the crux cordis. The SCV (lower yellow arrow) runs in close association with the right coronary artery (RCA) (purple arrow). Right = the CS and SCV (yellow arrows) and RCA (purple arrow) on the transverse plane. (B) Variant 2. The CS enters the RA independently from the anterior cardiac veins. Right = the ostia of the CS, PIV, and PVLV are confluent and form a large common ostium (arrow). (C) Variant 3. Left = the PIV is not connected to the CS, but enters the RA independently, as is also demonstrated on the transversal orthogonal plane in the right panel. The purple arrows indicate the PIV and a right marginal vein (RMV); the yellow arrow indicates the CS. (D) This MSCT scan is of a patient who, besides the PIV, lacks CS tributaries. Although the ostium is rather large, more distal from the ostium, the CS narrows, as demonstrated on a volume-rendered reconstruction (left panel) and on a curved multiplanar reformatting (right panel). Abbreviations as in Figure 1.
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