Application Study Of Multidetector Computed Tomography To Visualize The Cardiac Veins

Background and objective:Cardiac resynchronization therapy (CRT) has become an attractive treatment option for highly symptomatic heart failure patients with a broad QRS complex on the surface electrocardiogram and poor left ventricular (LV) systolic function. In selected patients, CRT reduces symptoms and improves exercise capacity.In cardiac resynchronization therapy (CRT), left ventricular(LV) pacing is achieved by positioning the LV lead in one of the tributaries of the coronary sinus (CS). Failure of LV lead placement has been attributed to the inability to insert catheters in the CS and the lack of suitable side branches. So important pre-implantation issue is knowledge of the cardiac venous anatomyof the candidate. Until recently, the cardiac venous system could only be evaluated invasively using Anterograde or retrograde venography, either by direct manual contrast injection or after occlusion of the coronary sinus. This study was designed to evaluate the value of three method to visualize the cardiac veins and evaluate the relation between variations in venous anatomy through MDCT, Anterograde or retrograde venography.Materials and methods:55consecutive heart failure patients scheduled for CRT implantation and20 patients were prospectively enrolled to undergo double source computerized tomography(DSCT) to visualize the venous system, invasive venography during device implantation, and Anterograde venography were underwent during coronary artery graphy. The different image series were stored digitally and analyzed by an experienced observer. Images were first analyzed to identify the tributaries of the coronary sinus and presence of1st degree side branches. The proximal vein diameters of the coronary sinus, posterior interventricular vein, posterior vein of the left ventricle, and left marginal vein were measured after catheter-based image calibration. All analyses were performed with the statistical software program SPSS16.0.Results:33individuals of55chronic heart patients were performed coronary venography,53individuals performed RCV, and40individuals performed DSCT before CRT. All of20normal heart function patients were performed DSCT. The relation ratio in DSCT and RCV is0.944(P<0.001), and the relation ratio in CVG and RCV is0.42(P<0.05).Conclusion:Visualization of major tributaries of the coronary sinus was comparable between Anterograde or retrograde invasive venography and DSCT venography.So, a coronary angiographical study, including examination of the coronary venous return prior to implantation of a CRT device, can simplify the device implant and allows patient-specific preselection of appropriate tools for the procedure. Furthmore, Non-invasive evaluation of cardiac veins with DSCT is feasible. There is considerable variation in venous anatomy.