The Anatomic Study Of The Coronary Venous System Via Multi-slice Spiral Computed Tomography

Objective: To retrospectively analyzed the clinical data of multi-slice spiral CT coronary angiography in our hospital,and to explore the anatomy and variation of coronary venous system and its influencing factors based on the optional phase of coronary venous system.Methods: 199 adult patients with chest pain and tightness were enrolled from January2016 to April 2016 in the first hospital of Ji Lin University,including 106 male and 93 female.The mean age in this study cohort was 53 years old(range 26~80 years old).All patients underwent coronary arterial angiography via multi-slice spiral computed tomography(MSCT).On the basis of the original imaging data obtained from MSCT,we reconstructed the phase of 10~100% at 10% interval on SIEMENS workstation and transferred them to picture archiving and communication system(PACS).Then,imaging quality of volume reconstruction about coronary veins was scored and determined the optional phase for further investigation.Based on the best phase solely,multiplanar reformation(MPR)and volume reconstruction(VR)imaging were acquired on PACS.On MPR and VR imaging,we observed and measured the morphology,location,diameter,angle and length of the coronary sinus and its branches.Meanwhile,from the aspects of age,gender and the degree of coronary arterial stenosis,we utilized analysis of variance and independent sample t-test to perform statistical analysis for those data above.All statistical analyses were performed using the SPSS.17.0 software package.A value of P<0.05 is considered to be statistically significant.Results: 1.The imaging evaluation regarding the status of coronary sinus and its branches about coronary venous system: a better stage of coronary venous system imaging was 30%,40%,60% and 70%,and there are no statistical significance between them.For this study,we chose the 40% phase as the standard stage.Coronary sinus(CS),great cardiac vein(GCV)and middle cardiac vein(MCV)were demonstrated by MSCT in 199 patients(100%).Lateral wall vein was demonstrated by MSCT in 189 patients(94.97%),posterior ventricular left vein(PVLV)in 192patients(96.48%),small cardiac veins(SCV)in 42 patients(21.11%),marshall vein in2 patients(1.01%).Posterior ventricular left vein were demonstrated one two three vessels by MSCT in 160 patients(80.0%),absent in 7 cases(3.5%).Lateral wall vein were demonstrated one two four vessels by MSCT in 181 patients(91%),absent in 10case(5%).2.The located relationship between coronary sinus and mitral anulus and its morphology: coronary sinus was located above mitral anulus in 186 patients(93.5%),and located at the same lever with mitral anulus in 13 cases(6.5%);the morphology of coronary sinus are basically two types of trumpet-shape and tubular.The former were demonstrated in 119 patients(60%),and the latter in 80 patients(40%).3.The adjacent relationship between coronary veins and coronary arteries:right coronary artery(RCA)demonstrated by MSCT in 86 cases(43.22%)were crossed with MCV,and were accompanied by 41 cases(20.60%)with MCV;left circumflex coronary artery(LCX)demonstrated by MSCT in 85 cases(42.71%)were intersected with great cardiac vein and side wall vein;left anterior descending artery(LAD)in 101 case(50.75%)were intersected with the first diagonal branches,and were accompanied with the great cardiac vein.4.Variation of at the termination of coronary venous: there are 20 cases(10%)for SCV draining into coronary sinus,and 22 cases(11%)into MCV,and there was 1 case(0.5%)with left superior vena cava.5.Effects of the gender,age and degree of coronary arterial stenosis on coronary venous anatomy: the gender on coronary venous anatomy is without statistical significance;in no stenosis group,there was significant difference in the posterior ventricular left vein diameter(P=0.012)in patients between the less than 44 and older than 60 years;in stenosis group,there was significant difference in the posterior ventricular left vein diamete(P=0.043)in patients between the older than 45 and less than 59 and older than 60 years;in stenosis group,there was significant difference in the angle of the side wall of vein(P=0.027)in patients between the less than 44 and older than 45 and less than 59 years;there was significant differencebetween the stenosis group and no stenosis group in the diameter of the middle cardiac vein and the angle of the posterior ventricular left vein(P=0.044,0.002);Age and whether coronary stenosis or not had statistical significance on the anatomy and variation of some coronary vein branches.Conclusion: 1.Multi-slice spiral CT coronary angiography can not only demonstrated the anatomy and variation of coronary venous system,but also observe the relationship to its adjacent organs and coronary arteries so as to provide useful information for cardiac electrophysiology.2.Gender factors have nothing to do with the anatomy and variation of the coronary venous system.Age and the stenosis or not of coronary arteries have statistical significance about the impact for some branches of coronary veins.