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MDCT evaluation of the cardiac venous system

Valutazione mediante TCMS del sistema venoso coronarico

  • Cardiac Radiology/Cardioradiologia
  • Published:
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Abstract

Purpose

This study was undertaken to evaluate the usefulness of electrocardiographically (ECG)-gated multidetector-row computed tomography (MDCT) for the assessment of the coronary venous system and detection of its anatomical variants, in order to identify those suitable for lead placement in cardiac resynchronisation therapy (CRT).

Materials and methods

We retrospectively examined the coronary MDCT studies of 89 patients (73 males, 16 females, average age 62.5 years, range 31–79) referred for suspected coronary artery disease. The cardiac venous system was assessed in all patients using three-dimensional (3D) postprocessing on a dedicated Vitrea workstation (five patients were excluded from the analysis).

Results

The coronary sinus, the great cardiac vein, the anterior interventricular vein and the middle cardiac vein were visualised in all cases. The lateral cardiac vein was visualised in 56/84 patients (67%) and the posterior cardiac vein in 63/84 patients (75%), never both missing. Along the postero-lateral wall of the left ventricle, only one branch was present in 44 cases, two branches in 21 cases and three or more branches in 19/84 cases (22%). Evaluation of the maximum diameter revealed that the lateral vein was dominant over the posterior vein in 20/40 cases. The small cardiac vein was visualised in 11/84 cases.

Conclusions

MDCT provides good depiction of the cardiac venous system, enabling the study of the vessel course and the identification of anatomical variants. Hence, this imaging technique could be proposed for the preoperative planning of CRT in selected patients.

Riassunto

Obiettivo

Scopo del nostro lavoro è valutare l’utilità della tomografia computerizzata multistrato (TCMS) nell’individuazione delle varianti anatomiche del sistema venoso coronarico al fine di riconoscere quelle ritenute più idonee per l’impianto dell’elettrocatetere necessario per la terapia di resincronizzazione cardiaca (CRT).

Materiali e metodi

Sono stati valutati retrospettivamente 89 pazienti consecutivi (73 maschi e 16 femmine, età media 62,5 anni, range di età 31–79), sottoposti ad angio—TCMS per sospetta patologia coronarica. Abbiamo valutato il sistema venoso coronarico in tutti i pazienti utilizzando una workstation dedicata Vitrea per il postprocessing 3D (5 pazienti sono stati esclusi).

Risultati

Il seno coronarico, la grande vena cardiaca, la vena interventricolare anteriore e la vena cardiaca media sono state visualizzate in tutti i pazienti. La vena cardiaca laterale è stata visualizzata in 56/84 casi (67%), mentre la vena cardiaca posteriore in 63/84 casi (75%); in nessun caso mancavano entrambe. Complessivamente in prossimità della parete postero-laterale del ventricolo sinistro è stato possibile visualizzare un solo ramo in 44 casi, due rami in 21 casi, tre o più rami in 19 casi. Nei pazienti che presentavano due rami per la parete posterolaterale del ventricolo sinistro, valutando il calibro massimo della vena, la vena laterale è stata considerata dominante sulla posteriore in 20/40 casi. La piccola vena cardiaca è risultata visualizzabile in 11/84 casi.

Conclusioni

La TCMS permette una buona visualizzazione delle vene coronariche, consentendo lo studio del decorso vasale e l’identificazione delle varianti anatomiche. Pertanto, questa tecnica di imaging potrebbe essere proposta nel planning dei pazienti da sottoporre alla CRT.

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Authors and Affiliations

  1. Department of Radiology, University of Insubria, Ospedale di Circolo, Varese, Italy

    D. Lumia, D. Laganà, A. Canì, M. Mangini, A. Giorgianni, T. Cafaro, E. Bertolotti, S. Rizzo, E. Cotta, G. Carrafiello & C. Fugazzola

  2. Department of Cardiology, University of Insubria, Ospedale di Circolo, Varese, Italy

    F. Caravati

  3. Department of Cardiology, Ospedale di Circolo, Varese, Italy

    I. Caico

  4. Department of Medical Physics, Ospedale di Circolo, Varese, Italy

    C. Vite

  5. University of Insubria, Ospedale di Circolo, Viale Borri 57, 21100, Varese, Italy

    D. Lumia

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  1. D. Lumia
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  2. D. Laganà
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  3. A. Canì
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  4. M. Mangini
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  14. C. Fugazzola
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Correspondence to D. Lumia.

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Lumia, D., Laganà, D., Canì, A. et al. MDCT evaluation of the cardiac venous system. Radiol med 114, 837–851 (2009). https://doi.org/10.1007/s11547-009-0417-3

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  • DOI: https://doi.org/10.1007/s11547-009-0417-3

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