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. 2018 Sep;26(9):433-444.
doi: 10.1007/s12471-018-1132-2.

Visualisation of coronary venous anatomy by computed tomography angiography prior to cardiac resynchronisation therapy implantation

U C Nguyên  1   2 , M J M Cluitmans  3 , J G L M Luermans  3 , M Strik  3 , C B de Vos  3 , B L J H Kietselaer  3   4 , J E Wildberger  4 , F W Prinzen  5 , C Mihl  4 , K Vernooy  3   6
Affiliations

Visualisation of coronary venous anatomy by computed tomography angiography prior to cardiac resynchronisation therapy implantation

U C Nguyên et al. Neth Heart J. 2018 Sep.

Abstract

Background: The purpose of this study was to illustrate the additive value of computed tomography angiography (CTA) for visualisation of the coronary venous anatomy prior to cardiac resynchronisation therapy (CRT) implantation.

Methods: Eighteen patients planned for CRT implantation were prospectively included. A specific CTA protocol designed for visualisation of the coronary veins was carried out on a third-generation dual-source CT platform. Coronary veins were semi-automatically segmented to construct a 3D model. CTA-derived coronary venous anatomy was compared with intra-procedural fluoroscopic angiography (FA) in right and left anterior oblique views.

Results: Coronary venous CTA was successfully performed in all 18 patients. CRT implantation and FA were performed in 15 patients. A total of 62 veins were visualised; the number of veins per patient was 3.8 (range: 2-5). Eighty-five per cent (53/62) of the veins were visualised on both CTA and FA, while 10% (6/62) were visualised on CTA only, and 5% (3/62) on FA only. Twenty-two veins were present on the lateral or inferolateral wall; of these, 95% (21/22) were visualised by CTA. A left-sided implantation was performed in 13 patients, while a right-sided implantation was performed in the remaining 2 patients because of a persistent left-sided superior vena cava with no left innominate vein on CTA.

Conclusion: Imaging of the coronary veins by CTA using a designated protocol is technically feasible and facilitates the CRT implantation approach, potentially improving the outcome.

Keywords: Cardiac resynchronisation therapy; Computed tomography angiography; Coronary veins; Fluoroscopic angiography.

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Conflict of interest statement

Conflict of interest

U.C. Nguyên received a Kootstra Talent Fellowship research grant from Maastricht University and was additionally funded by a research grant from MS from the Dutch Heart Foundation (grant #2015T61). M.J.M. Cluitmans is supported by the Hein Wellens Fonds and is part-time employed by Philips. J.E. Wildberger received institutional grants from Agfa, Bayer, GE, Phillips, and Siemens and speaker fees from Bayer and Siemens. F.W. Prinzen received research grants from Medtronic, Abbott, LivaNova, Biosense Webster, MSD, and Biotronik. K. Vernooy received research grants from Medtronic and Abbott. J.G.L.M. Luermans, M. Strik, C.B. de Vos, B.L.J.H. Kietselaer and C. Mihl declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Coronary venous classification used in the present study shown on 3D computed tomography angiography (CTA) images (a) and 2D fluoroscopic angiography (FA) images of patient 14 (b). LAO left anterior oblique, RAO right anterior oblique
Fig. 2
Fig. 2
A 78-year-old woman (patient 16) who had undergone an unsuccessful cardiac resynchronisation therapy implantation 5 years earlier as no lateral vein on FA (a) was accessible for left ventricular lead placement. CTA in 3D (b) and 2D (c) revealed a single small and stenotic LTV and CS branching. AV anterior vein, CS coronary sinus, IV inferior vein, LA left atrium, LAO left anterior oblique, LTV lateral vein, RA right atrium, RV right ventricle
Fig. 3
Fig. 3
CTA and FA of a 77-year-old woman (patient 4, a) and a 49-year-old woman (patient 10, b) with a left-sided persistent superior vena cava (SVC, red arrow) and CS dilatation. Note the sharply angulated vein (white arrow) in patient 4 (a) and the limited coronary venous anatomy in patient 10 (b). ALV anterolateral vein, AV anterior vein, CS coronary sinus, ILV inferolateral vein, IV inferior vein, LA left atrium, LAO left anterior oblique, RA right atrium, RAO right anterior oblique, RV right ventricle
Fig. 4
Fig. 4
Coronary veins on CTA and FA with final left ventricular lead position. ALV anterolateral vein, AV anterior vein, CS coronary sinus, ILV inferolateral vein, IV inferior vein, LTV lateral vein, RV right ventricle, SVC superior vena cava
See this image and copyright information in PMC

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