Prospective evaluation of the anatomy of the coronary venous system using multidetector row computed tomography

Multidetector row computed tomography (MDCT) is a developing technique mainly used to evaluate the coronary arteries, but less attention has been paid to the coronary venous system. However, with the dramatic technological advancement of percutaneous therapies for heart failure or mitral insufficiency, a better knowledge about the anatomy of the coronary venous system may be of great utility. We sought the efficacy of MDCT imaging to delineate the coronary venous system.

16 row MDCT scans were performed in 50 consecutive patients (42 men, age 61+/-15 years, all in sinus rhythm). The inter-individual variability in terms of diameter, distance, angle of the main tributaries of the coronary venous system was reported.

The coronary venous system was always visualized. A remnant Thebesian valve was observed in 18 patients, the diameter of the coronary sinus ostium was found 12.2+/-3.6 mm and 15.3+/-3.7 mm respectively in the antero-posterior and supero-inferior directions, the distance between the posterior vein of the left ventricle (PVLV) and the anterior interventricular vein (AIV) was found 108.6+/-15.2 mm with a significant correlation with the mitral annulus diameter (p<.002) and the left ventricular diameter (p<0.01). The left marginal vein (LMV) was more often tortuous when the angle between the LMV and the great cardiac vein was less than 60 degrees (p<0.01).

16 row MDCT imaging can be used to investigate non-invasively the coronary venous anatomy and may serve as a useful tool before percutaneous therapies involving the coronary veins.