Role of multidetector computed tomography coronary angiography in delineating the normal anatomy of the coronary venous system.

Abstract

Background: The coronary venous system is a commonly used route of entry to the heart. It is being used increasingly for various electrophysiological purposes, as cardiac resynchronization therapy (CRT) in treating arrhythmias and heart failure. Multi-detector Computed Tomography (MDCT) coronary angiography is an excellent non-invasive modality in visualizing cardiac veins anatomy as well as being an alternative tool for invasive retrograde cardiac venography.
This study aimed to delineate the normal anatomy of the coronary venous system before CRT using MDCT coronary angiography with multi-planar reformation (MPR) and three-dimensional (3D) reconstruction.
Methods: The study was done in Zagazig university hospitals in the period from June 2019 to February 2020. Thirty patients with normal heart rate were enrolled (60% males and 40% females; mean age: 55.87±12.02 years, range: 26–71 years), who underwent elective MDCT coronary angiography using 128-slice MDCT scanner (Ingenuity Phillips health care, best Netherlands).
Results: The systolic phase of cardiac cycle (45%) was the best phase where most cardiac veins were best seen. Coronary Sinus (CS), Great Cardiac Vein (GCV), Anterior Interventricular Vein (AIV) and Middle Cardiac Vein (MCV) were visualized in all cases (100%). Thebesian valve was observed in (73%). The diameter of the CS ostium in the superoinferior direction (mean 17.2 ± 2.55) was significantly larger than that in the anteroposterior direction (mean 12.58 ± 2.44).
Conclusions: This study showed that MDCT coronary angiography is a promising imaging modality in the delineation of cardiac veins anatomy. Also, it can offer information about their relationship with adjacent anatomical structures.