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Updated: Aug 17, 2026
Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Topographic analysis of the coronary sinus and major cardiac veins by computed tomography
Kristina Lemola1, Gisela Mueller, Benoit Desjardins
1Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-0311, USA.
Insights
Radiofrequency ablation in the coronary sinus (CS) requires caution, as the CS is often adjacent to the esophagus and coronary arteries. This study used CT scans to map these structures, revealing close proximity in most patients.
Area of Science:
- Cardiovascular anatomy
- Interventional cardiology
Background:
- The coronary sinus (CS) and its branches are implicated in arrhythmias.
- Radiofrequency (RF) energy application within the CS may be required for treatment.
- Atrio-esophageal fistula is a known complication of left atrial ablation.
Purpose of the Study:
- To delineate the in vivo topographic anatomy of the coronary sinus (CS), esophagus, and coronary arteries.
- To utilize computed tomography (CT) for detailed anatomical visualization.
Main Methods:
- Fifty patients underwent helical contrast CT with 3D and endoscopic reconstructions.
- Images were reformatted to assess spatial relationships between the CS, esophagus, and coronary arteries.
- The thickness of intervening tissue layers was measured.
Main Results:
- The esophagus was adjacent to the CS in 80% of patients, with a mean fat layer of 1 mm.
- The right coronary artery was within 5 mm of the CS in 80% of patients.
- The circumflex artery was consistently within 5 mm of the CS.
Conclusions:
- The CS is frequently in close proximity to the esophagus and coronary arteries.
- Caution is advised during RF ablation in the CS to avoid injury to adjacent structures.
Background:
The coronary sinus (CS) and its branches may play a role in the genesis of various arrhythmias. Applications of radiofrequency energy within the CS may be necessary. Atrio-esophageal fistula has been recognized as a complication of ablation along the posterior left atrial wall.
Objectives:
The purpose of this study was to describe the in vivo topographic anatomy of the CS, esophagus, and coronary arteries using computed tomography (CT).
Methods:
Helical contrast CT of the heart with three-dimensional and endoscopic reconstructions was performed in 50 patients (28 men and 22 women; mean age 54 +/- 10 years). The images were reformatted to determine the relationships among the CS, adjacent blood vessels, and esophagus and to determine the nature and thickness of surrounding tissue layers.
Results:
Mean CS ostium diameter was 12 +/- 4 mm, and mean thickness of the periosteal fat layer was 3 +/- 2 mm. In 40 of the 50 patients (80%), the esophagus was adjacent to the CS, starting 24 +/- 9 mm from the ostium, and remained in contact for a mean length of 7 +/- 5 mm. Mean thickness of the fat layer between the esophagus and CS was 1 +/- 1 mm, and mean thickness of the anterior wall of the esophagus was 3 +/- 2 mm. In 10 patients (20%), there was no contact between the esophagus and CS. In 40 patients (80%), the right coronary artery was less than 5 mm from the CS (minimum distance 1 +/- 1 mm) over a mean length of 17 +/- 11 mm. In all patients, the circumflex artery was less than 5 mm from the CS (minimum distance 1 +/- 0.4 mm) over a mean length of 16 +/- 9 mm in patients with right-dominant coronary circulation and over a mean length of 86 +/- 11 mm in patients with left-dominant coronary circulation.
Conclusion:
The CS often lies very close to the esophagus and coronary arteries. During radiofrequency energy ablation in the CS, caution should be exercised to prevent injury to surrounding structures.
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