Anatomy of the coronary sinus with regard to cardiac resynchronization therapy implantation

Abstract

Knowledge of the coronary sinus (CS) anatomy is crucial for implantation of cardiac resynchronization therapy (CRT). Obstacles to CS entry, such as the Eustachian ridge and Thebesian valve, as well as within the CS, such as Vieussen’s valve and the vein of Marshall, are important to understand and differentiate during implantation or to identify earlier by imaging. Anatomic knowledge is mandatory to select the most suitable side branch for lead implantation. Modern tools and techniques almost always enable other anatomic problems, such as tortuous, small, short, or overly straight side branches, to also be overcome.

Coronary sinus angioplasty to enable optimal left ventricular lead placement for resynchronization

“…Besides the etiology of the cardiomyopathy (ischemic versus non-ischemic), factors such as CS anatomy, tributary distribution and final LV lead positioning highly affect the response to CRT. Anatomical obstacles in the CS network (venous valves, stenosis, tortuosity of the target vein, among others) represent a major challenge for the operator [ 2 ]. Concerning CS or branch stenosis, balloon angioplasty seems to achieve high rates of successful transvenous LV lead placement.…”