Angiographic Features Of The Cardiac Vein System

Purpose: Cardiac vein system mainly includes coronary sinus and its tributaries, which is an important component of the human heart venous system and an important symbol to the cardiac electrophysiology. They are also important targets to many heart disease diagnosis and treatment. Cardiac resynchronization therapy(CRT) of refractory heart failure has become the main mode modern of cardiac pacing. CRT generally required insert leads in the left ventricular. In this case people need to know the anatomy of cardiac vein system. The attention to the cardiac vein system has gradually strengthened in recent years. The research methods of anatomy for coronary venous system usually uses the delayed enhancement when coronary angiography heart venous system, the coronary venous retrograde angiography and echocardiogram, MDCT enhancement method, etc. To study the angiographic features of the cardiac vein system - the coronary sinus (CS) and its tributaries, it can help the clinical practice of the middle cardiac vein in interventional cardiology.Subjects: A total of 200 patients who were initial diagnosed as coronary heart disease in the second hospital of Hebei medical university were enrolled between october 2009 and october 2010. The age of all patients was 28～79 years old, mean age was 56.41±9.42 years old, including 145 male and 55 female. All of the patients had been initial diagnosed as coronary heart disease by their symptoms, signs, auxiliary examination (ECG, ECT, Enzymes, CTA) and these patients need to examine angiocardiography.Methods: All patients including 170 patients with coronary heart disease and 30 patients who without coronary heart disease after angiocardiography. The venous phase of coronary arteriography was used to examine the position, morphology, diameter, number and angulation of the coronary sinus (CS) and its tributaries in 200 patients. CS and its tributaries were observed and recorded in the right anterior oblique, left anterior oblique and postero-anterior position. We need to measure the maximum diameter of the CS, the middle cardiac vein (MCV), the left-posterior vein (LPV) and the great cardiac vein (GCV). All patients were divided into 2 groups according to two methods: 1) sex; 2) the existence of coronary heart disease.Comparing the diameter of the CS and its tributaries in different sex and the patients who had or not coronary heart disease.Statistical analysis: All statistical analysis was performed using SPSS 17.0 software. Continuous variables were expressed as the mean value and standard deviation. Categorical variables were summarized as percentage. The comparison of experimental data in the sex and coronary artery disease was evaluated by Independent-samples t test. Statistical significance was defined as P < 0.05.Results: Morphology of the CS: The number of the patients whose CS were tubular-shaped was 154, the other whose CS were bell-shaped was 46. The coronary sinus (CS) and great cardiac vein (GCV) were visualized in all patients, The detection rate of middle cardiac vein (MCV) was 99.5%, the MCV was alone in almost all patients, only three patients had double MCV, only one patient (male) had not MCV, Mean diameter of the MCV was 4.44±0.88mm; Mean diameter of the MCV among the male was 4.44±0.89mm, Mean diameter of the MCV among the female was 4.42±0.86mm; Mean diameter of the MCV in the patients who were diagnosed as coronary heart disease was 4.42±0.89mm, Mean diameter of the MCV in the patients who were not diagnosed as coronary heart disease was 4.57±0.84mm. 1～3 left posterior vein (LPV) were visualized in 199 patients. only one patient had not LPV; Mean diameter of the LPV was 3.67±0.71mm; Mean diameter of the LPV among the male was 3.67±0.70mm, Mean diameter of the LPV among the female was 3.68±0.75mm; Mean diameter of the LPV in the in the patients who were diagnosed as coronary heart disease was 3.67±0.72mm, Mean diameter of the LPV in the patients who were not diagnosed as coronary heart disease was 3.70±0.68mm. We could concluded that the sex and whether or not coronary heart disease on the diameter of the coronary sinus and its tributaries had no effect by statistical analysis (P>0.05). CRT generally require through the coronary sinus or one of its tributaries for inserting leads in addition to the right atrium and right ventricle. The diameter of the MCV and the diameter of the LPV drained the CS at an approximately 90o angle, and this angulation might cause technical difficulties through coronary sinus, the MCV or the LPV inserting a left ventricular pacing lead. But the GCV drained the CS at an approximately 180o angle, the GCV remained in the same axis as the CS in the left atrio ventricular groove and the diameter of the GCV was 3.12±0.61mm. So the GCV was the best position or the first choice when during inserting a left ventricular pacing lead through the CS and its tributaries.Conclusions: Through the angiographic features of the CS and its tributaries, we had concluded that the sex and whether or not coronary heart disease on the diameter of the coronary sinus and its tributaries had no effect. We could conclude that the GCV might the best position when during inserting a lead through compared the position, diameter and angulation in the MCV, GCV, LPV. The angiocardiography features of the CS and its tributaries are benefits for inserting lead for pacing during CRT.