Assessment Of The Relationship Between The Coronary Venous And Arterial Systems Using 256-Slice Computed Tomography

Background:The coronary venous system(CVS)has been brought into clinical focus because it plays an important role in many interventional cardiac procedures.The anatomical variability of the CVS increases the risk and difficulty of these operations.Therefore,there are more papers describing this complex anatomy.However,the literature with respect to the relationship between the coronary venous and arterial systems is scarce.To our knowledge,no study has been conducted to evaluate the coronary venous and arterial systems using the 256-slice CT.In fact,the relationships between other main tributaries with their corresponding arteries are also important because some interventional operations within the coronary veins such as RFA may cause adjacent cardiac artery injuries.A thorough knowledge of the relationship before some operations has important clinical value.Objective:To systematically assess the coronary venous system and the spatial relationship between the main tributaries and their corresponding coronary arteries by using 256-slice CT,which can provide guidance for the patients who need interventional cardiac procedures.Materials and Methods:A total of 101 subjects(50 male and 51 female)with an average age of 59.4 years old(range from 39 to 82)were retrospectively analyzed in this study.All of them were previous patients who had coronary CT angiography between June 2018 and February 2019.All of them had this examination for suspected coronary artery disease.A dedicated workstation was used for image evaluation.The following cardiac veins were evaluated:the coronary sinus(CS),great cardiac vein(GCV),anterior interventricular vein(AIV),posterior interventricular vein(PIV),posterior vein of the left ventricle(PVLV),left marginal vein(LMV),small cardiac vein(SCV),and the Marshall vein(MV).The locations diameter of each identified tributary,the angle between tributaries and the CS-GCV,the distance respectively from the CS ostium,as well as from the crossing point to the ostium of the corresponding tributaries were detected and measured.Statistical analysis was performed by using SPSS Statistics 20 software.Categorial data were presented as numbers and percentages.Continuous data were expressed as mean values and corresponding standard deviations.The Student t test was applied to assess differences between the diameters of the CS ostium in two directions and the distance from the crossing point to the ostium of corresponding tributaries at the medial and lateral orientations.Results:1.The CS,GCV,PIV and AIV were visualized in all subjects(100%).The PVLV and LMV were identified in 98(97.0%)and 92(91.1%)subjects,respectively.The Marshall vein was detected in only one subject.There were 17(17.3%)subjects having 2 PVLVs and 17(18.5%)subjects having 2 or 3 LMVs.The SCV was observed in 13(12.9%)subjects,53.8%of which directly drained into the CS and 46.2%into the PIV.2.The mean diameters of the CS ostium in the anteroposterior and superoinferior direction were 12.5 ± 2.3 mm and 9.2 ± 2.5 mm,respectively(P<0.05).The proximal and distal diameters of the GCV were 9.1 ± 2.1 mm and 3.9 ± 0.9 mm,respectively.The diameter of PIV,PVLV,LMV,and AIV were 5.3 ± 1.3mm,3.1±1.2mm,2.4 ± 0.8mm,3.8±0.9mm;the angle between the identified tributaries and the CS/GCV were 83.0±2.4°,109.9±25.5°,109.9 ± 25.5°,116.6±29.3°,141.2± 19.9°;the distances from the CS ostium to the ostium of corresponding tributaries were 6.2 ± 2.8mm,24.9 ± 9.0mm,65.4± 12.5mm,95.3± 13.7mm.The diameter of SCV was 3.5 ± 1.1mm?3.The following five pairs of veins and arteries had a higher frequency of intersecting compared with others:the CS/GCV and the left circumflex coronary artery(LCX)(97.1%),the AIV and the diagonal or ramus branch(92.1%),the PIV and the posterior branch of left ventricle artery(LPA)(88.1%),the LMV and the circumflex or circumflex marginal(73.9%),and the PVLV and the circumflex or circumflex marginal(31.6%).The other two pairs had a higher frequency of running parallel to each other:the AIV and the anterior descending artery(LAD)(76.2%)and the PIV and the posterior descending artery(PDA)(54.4%).Most tributaries were lateral to their corresponding arteries at the crossing point except for the AIV.4.The distance when the PVLV was lateral to the circumflex or circumflex marginal at the crossing point was smaller than the distance when the PVLV was medial(13.0 ± 13.0 mm vs 30.5 ± 16.9mm)(P<0.05).A similar observation between the PIV and PDA was also noted(18.5 ± 7.8mm vs 27.0 ±9.2mm)(P<0.05).Conclusion:1.The anatomical relationship between the coronary venous and arterial systems is variable in location and proximity.Invasive procedures performed on the coronary venous system should be done with knowledge of the anatomical variations is significance.2.The coronary venous system and its tributaries,and the spatial relationship between the coronary venous and arterial systems were examined with details by using a 256-slice CT,which can provide guidance for the patients who need interventional cardiac procedures.