Anatomia angiográfica do sistema venoso coronário. Aplicações em eletrofisiologia clínica

Abstract

Purpose -To study the angiographic anatomy of human coronary veins and the possibility of epicardial venous mapping through microelectrode catheters.Methods -We evaluated 30 patients with sustained ventricular tachycardia using a catheter which provided occlusion of the coronary sinus ostium during venous angiography. They were 25 males, 5 females, ages ranging from 24 to 76 years (mean=52.7). The veins were studied according to their number, caliber and distribution in the anterior and posterior wall of the left ventricle.Results -Coronary sinus was catheterized in all patients. No discomfort or complications were observed. The number of veins from posterior wall of the left ventricle was 3.1 and anterior wall, 1.9, p<0.05. The caliber of the coronary veins were: anterior interventricular vein (distal segment = 1.19±0.22mm, midle segment = 1.65±0.35mm), posterior interventricular vein (distal segment = 1.83±0.47mm, midle segment = 2.00±0.52mm), left posterior vein (distal segment = 1.45±0.25mm, midle segment = 2.49±0.92mm); p<0.05.Conclusion -The balloon occlusion technique for coronary venous angiography is feasible and safe. The number and the caliber (distal and midle) of the veins from the posterior wall of the left ventricle were significantly greater than those from the anterior wall. Anatomic conditions for venous epicardial mapping are more adequate in the posterior wall of the left ventricle. Key words: coronary angiography, vein, ventricular tachycardiaObjetivo -Avaliar as possibilidades diagnósticas e terapêuticas, através de microcateteres introduzidos nas veias do coração, em estudo angiográfico da circulação venosa coronária.Métodos -Foram realizadas venografias superseletivas do coração em 30 portadores de taquicardia ventricular sustentada, utilizando-se cateter específico que providenciava a oclusão temporária do óstio do seio coronário. A idade média foi de 52,7 (variação de 24 a 76) anos, sendo 25 do sexo masculino e cinco do feminino. As veias foram analisadas de acordo com o número, calibre e distribuição nas paredes anterior e posterior do ventrículo esquerdo (VE).Resultados -O seio coronário foi cateterizado em todos os pacientes, não havendo desconforto adicional ou complicações em nenhum caso. O número de veias da parede posterior do ventrículo esquerdo foi 3,1 e na parede anterior, 1,9 p<0,05. Calibres das veias coronárias observados: veia interventricular anterior (segmento distal = 1,19±0,22mm, segmento médio = 1,65±0,35mm); veia interventricular posterior (segmento distal = 1,83±0,47mm, segmento médio = 2,00±0,52mm); veia posterior do VE (segmento distal = 1,45±0,25mm, segmento médio = 2,49±0,92mm); p<0,05.Conclusão -A técnica de oclusão para o estudo das veias coronárias é exeqüível e segura. O número e o calibre (segmentos médio e distal) das veias da parede posterior do VE são significantemente maiores do que da parede anterior, sugerindo que condições anatômicas para o mapeamento elétrico epicárdico, através das veias coronárias, são mais adequadas na parede posterior do VE. , n...

Morphologic description of great cardiac vein in pigs compared to human hearts

“…The mean calibers of the GCV found in our study at the interventricular sulcus and at the distal segment (3.73 mm and 5.3 mm, respectively), are consistent with the majority of the reports from studies in humans [ 4 , 9 , 16 , 21 , 22 ] .…”

“…The venous communication found between the GCV and the MCV at the heart apex (49%) in our study, is considerably more numerous than those reported in humans indicating ranges between 15-34% [ 5 , 8 , 9 , 11 , 14 , 16 ] . Melo et al [ 4 ] , in a study conducted in humans, reported venous communication of these veins in 90% of the cases, although they do not discriminate where these venous communication occurred. This morphological characteristic has been considered as protective because in certain pathophysiologic conditions allow to attenuate or prolong the history of the cardiovascular disease by providing alternative routes for venous drainage [ 8 ] .…”

“…The great cardiac vein (GCV) in humans drains into the coronary sinus (CS), the territories irrigated by the left coronary artery (LCA). This vein originates at the lower third of the anterior interventricular sulcus (AIS) or even at the heart apex, and continues its course along said sulcus in parallel to the anterior interventricular branch (AIB) to the upper portion of that arter [ 4 - 8 ] . Then it crosses to the left until it reaches the left atrioventricular sulcus (LAVS) forming the basis of the arterio-venous trigone of the heart (AVT) together with the AIB and the circumflex branch (CxB).…”

“…Its trajectory is mostly superficial with respect to the artery it runs along with. After a short run through the LAVS, the GCV, receives the drainage of the left posterior veins (PLCV) and gives origin to the SC [ 4 , 5 , 8 - 15 ] . The configuration of the AVT of the heart has been based on its crossing or not the GCV to the AIB and the CxB, which determines closed trigones when there is a crossing, or open trigones if the vein does not cross through these arterial branches.…”

Valves of the small coronary veins in porcine hearts

“…A significant increase in interest in the morphology of coronary veins and their valves occurred in the 1980s after the development of new treatment modalities in invasive cardiology and cardiac surgery via cannulation of the coronary veins, particularly the coronary sinus. The presence of valves in the small cardiac veins and absence of the valves in the Thebesian veins was confirmed by a series of studies conducted in the 1980s by Lüdinghausen and coworkers, who studied these vessels with the combination of injections and histological techniques (von Lüdinghausen, , , ; von Lüdinghausen, Ohmachi, Besch & Mettenleiter, ), and the work of other authors (Tschabitscher, ; Rosinia & Low ; Melo et al, ; Cendrowska‐Pinkosz & Urbanowicz, ; Gerber et al, ; Kozlowski et al, ; Ortale, Gabriel, Iost & Marquez, ; Ho, Sanchez‐Quintana & Becker, ). All authors, however, devoted their studies to the morphology of the central region of the venous bed of the heart, thus its outermost parts (including the intramyocardial segments) were neglected.…”