Non-Invasive Visualization of the Cardiac Venous System in Coronary Artery Disease Patients Using 64-Slice Computed Tomography
Nico R. Van de Veire, MD*, ,*,
Joanne D. Schuijf, MSc*,
Johan De Sutter, MD, PhD,
Dan Devos, MD ,
Gabe B. Bleeker, MD*,
Albert de Roos, MD, PhD ,
Ernst E. van der Wall, MD, PhD*,
Martin J. Schalij, MD, PhD* and
Jeroen J. Bax, MD, PhD*
* Leiden University Medical Center, Leiden, the Netherlands
Ghent University, Gent, Belgium; and the Departments of Radiology
Ghent University, Gent, Belgium
Leiden University Medical Center, Leiden, the Netherlands
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Figure 1 Volume-rendered reconstruction of the heart, posterolateral view. The first tributary of the coronary sinus (CS) is the posterior interventricular vein (PIV), running in the posterior interventricular groove. The second tributary of the CS is the posterior vein of the left ventricle (PVLV) with several side branches (asterisks). The next tributary is the left marginal vein (LMV). The great cardiac vein (GCV) will then continue as anterior cardiac vein in the anterior interventricular groove. Also note the circumflex coronary artery (CX) and right coronary artery (RCA).
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Figure 2 Measurement of the diameter of the coronary sinus (CS). The ostium of the CS was defined as the site where the CS makes an angle with the right atrium in the crux cordis area. This is best seen on the transverse plane. The diameter is first measured in the anteroposterior position (A). Multiplanar reformatting was then used to determine the size of the ostium in the supero-inferior direction on the coronal plane (B). LA = left atrium; RA = right atrium; RV = right ventricle.
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Figure 3 Example of measurement of the distance between the origins of the tributaries of the coronary sinus. LMV = left marginal vein; PIV = posterior interventricular vein; PVLV = posterior vein of the left ventricle.
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Figure 4 Presence of the CS and its main tributaries: PIV, PVLV, and LMV in the 3 subsets (control patients, patients with coronary artery disease [CAD], and patients with CAD and history of myocardial infarction). Abbreviations as in Figure 3. *p < 0.01; **p < 0.0001.
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Figure 5 Example of absence of the posterior and left marginal vein in a patient with a history of an anterolateral infarction. (A) Posterior view; (B) left lateral view. The only tributary of the coronary sinus (CS) and great cardiac vein (GCV) is the posterior interventricular vein (PIV). Also note the obtuse marginal (MO) branch of the circumflex coronary artery and the right coronary artery (RCA).
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Figure 6 Prevalence of both the posterior vein of the left ventricle (PVLV) and the left marginal vein (LMV), only the PVLV, and neither PVLV and LMV according to subject category: control patients, coronary artery disease (CAD) patients, and myocardial infarction patients. Overall p = 0.003.
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