Study On Coronary Venous System Anatomy Of Patients With Dilated Heart

Objective: Coronary vein sinus is an important part of the coronary venous system, through which all venous blood flows into right atrium. The major branches of coronary venous system are great cardiac vein(GCV), middle cardiac vein(MCV), small cardiac vein, posterior vein of left ventricle and oblique vein of left atrium. The coronary venous system anatomy is of great significance in electrophysiological examination, radio frequence ablation, implantation of artificial heart pacemaker and so on. The coronary venous system anatomy is of great significance in electro- physiological examination, radio frequence ablation, implantation of artificial heart pacemaker and so on. Because of the variation in coronary venous system anatomy, it is hard to choose an appropriate position during implanting an lead. If targeted vessel can not be reached, it seems difficult for CRT to work efficiently. What’s worse, CRT may stop responding deteriorating the heart condition. As a result, an increasing number of clinical trials which relate to coronary venous system anatomy have emerged. Currently, there are several universal acknowledged methods, such as coronary vein direct enhancement, coronary vein inverse development, multi detector computed tomography(MSCT) to show the coronary vein sinus and its branches. In this article, we will analyze the coronary venous system anatomy through coronary vein direct enhancement and coronary vein inverse development. The conclusion will be used to confirm the position of the tubes, searching an target spot or implanting a LV lead when making the electrophysiological examination.Methods: We have already made a rearch on the coronary venous system about 200 patients who had normal hearts. The conclusion had great significance in this study.Subjects: Patients dignosed with coronary heart disease(n=30, 19 male, 11 female, age 58.20±8.50 years)undergoing coronary angiography(CAG) from 2012-1-1 to 2014-12-31 were enrolled in this study. Patients(n=27, 21 male, 6 female, age 59.22±9.26 years, from 2012-1-1 to 2014-12-31) were also enrolled in the same study who included two parts, one was scheduled to undergo CRT. Those patients met current clinical criteria for CRT(New York Heart Association Class Ⅲ~Ⅳ, enlargement of the cardiac chamber, low EF). The other part was diagnosed with coronary heart disease or valvular heart disease, and the echocardiography have already displayed the enlargement of the cardiac chamber. Those patients were scheduled to undergo CAG. All patients meet no contraindication.Methods: All the images would be gathered in the position of RAO 30°, LAO 45° and AP. Two methods were used, one was coronary vein direct enhancement for CRT patients, the other was coronary vein inverse development for CAG patients. Both of them would be measured to evaluated morphology, position, angle, number and diameter. The maximum diameter of CS, the great cardiac vein(GCV), the middle cardiac vein(MCV) and the posterior vein of left ventricle(PLV) were recorded. Two groups were devided as before, the dilated heart group was assigned to two subgroups according to sex.Statistical analysis: All statistical analysis was performed using SPSS 17.0 software. Define P<0.05 as statistical significance.Results:1 In normal heart group(AP), the number of the patients whose CS were tubular-shaped was 16(53.3%), whose CS were bell-shaped was 14(46.7%). In dilated heart group, the number of the patients whose CS were tubular-shaped was 18(66.7%), whose CS were bell-shaped was 9(33.3%). There showed no significance(P=0.306).2 The position of the coronary sinus(AP):Horizontal Line: In normal heart group: there were 7 patients’ CSO 3 centrums below the bifurcatio tracheae(23.3%); 17 patients’ CSO 3.5 centrums below(56.7%); 5 patients’ CSO 4 centrums below(16.7%); 1 patient’s CSO 4.5 centrums below(3.3%). While in the other group: the numers are 3(11.1%), 13(48.1%), 10(37.0%), 1(3.8%) respectively. There was no significance(P=0.075).Mid-line: In normal heart group: there were 17(56.7%) patients’ CSO at the left side of spine, 10(33.3%) in the middle, 3(10.0%) patients at the right. In dilated heart group, the numbers were 11(40.7%), 10(37.0%), 6(22.3%) respectively. There was no significance(P=0.164).3 The angle of CSO(RAO 30°)In normal heart group, there were 9 patients(30.0%) on bottom right, the mean angle was 66.69°±10.27°(54.8°~81.6°); 3 patients(10.0%) were on right level, the mean angle was 91.73°±2.94°(89.1°~94.9°); 18 patients(60.0%) were on top right, mean angle was 112.06°±10.11°(96.5°~128.3°). In the other group, there were 8 patients(29.6%) with mean angle of 54.88°±13.20°(40.5°~79.1°), 2 patient(7.4%) with the mean angle of 91.9°±0.57°(91.5°~92.3°) and 17 patients(63.0%) with the mean angle of 113.27°±14.96°(97.9°~151.1°). P=0.867. There was no significance between two groups.4 The mean diameter of coronary vein sinus and GCV of normal heart group and dilated heart group(LAO 45°): CSO 8.39±1.62 mm & 13.01±4.77 mm(P=0.000), CS-MCV 7.01±1.88 mm & 11.24±5.25mm(P=0.000), CS-LPV 5.15±1.63 mm & 6.68±3.02mm(P=0.021), GCV 3.57±0.99 mm & 4.82±1.62 mm(P=0.001), MCV 3.37±1.09 mm & 5.71±1.47mm(P=0.000), LPV 2.62± 1.80 mm & 3.72±2.55mm(P=0.031). Above all, P<0.05, there was significance between two groups. We can come to the conclusion that patients whose cardiac cavities were dilated had greater coronary vein diameter than patients whose cardiac cavities were normal.5 We also divided dilated heart group into different subgroups by sex(LAO 45°).The mean diameter:CSO M 13.31±5.04mm&F 11.94±3.83 mm(P=0.544).CS-MCV M 11.46±5.71mm&F 10.37±3.03mm(P=0.689).CS-LPV M 6.35±3.05mm&F 7.81±2.89mm(P=0.307).GCV M 4.79±1.54 mm&F 4.94±2.05mm(P=0.845).MCV M 5.81±1.43mm&F 5.31±1.77mm CS coronary sinus冠状静脉窦CSO coronary sinus ostium冠状静脉窦口CS-MCV coronary sinus-middle cardiac vein冠状静脉窦-心中静脉CS-LPV coronary sinus-posterior vein of left ventricle冠状静脉窦-左室后静脉GCV great cardiac vein心大静脉MCV middle cardiac vein心中静脉PLV posterior vein of left ventricle左室后静脉LAO 45°left anterior oblique 45°左前斜位45°LAO 60°left anterior oblique 60°左前斜位60°RAO 30°right anterior oblique 30°右前斜位30°AP anteroposterior position正位CRT cardiac resynchronization therapy心脏再同步化治疗CRTD cardiac resynchronization therapy and implantable cardioverter defibrillator心脏再同步化治疗及埋心脏复律除颤器MA mitral annulus二尖瓣环AVNRT atrioventricular nodal reentrant tachycardia房室结折返性心动过速PSVT Paroxysmal supraventricular tachycardia阵发性室上性心动过速RA-CS-LA right atrium-coronary sinus- left atrium右心房-冠状静脉窦-左通路RVEDD right ventricular end of diatasis diameter右心室舒张末期内径LBBB Left bundle branch block完全性左束支传导阻滞(P=0.507).LPV M 3.88±2.81mm&F 3.17±1.29mm(P=0.556).Above all,P>0.05,there was no significant.As a result,they had no relationship.Conclusions:1 Through the comparison between two groups, we could draw the conclusion that there was no difference in the shape of the CSO.2 Through the comparison between two groups,the position and the angle of the CSO were the same.3 Through the comparison between two groups, the diameter of coronary vein system of dilated heart is greater than that of the normal heart.4 There was no difference between the groups devided by sex.