Coronary sinus anatomy

A complete understanding of the gross and radiographic cardiac anatomy is essential for successful cardiac resynchronization. Appreciation of the right atrial anatomy is necessary for coronary sinus cannulation. It is also important to understand that the right atrial and coronary sinus anatomy can be quite... 

Locating the coronary sinus os can be quite problematic, given the heart failure patient s distorted anatomy. Table 4.16 outlines the techniques devised to can-nulate the coronary sinus. If a simple stylet-driven lead coronary sinus placement is undertaken, then coronary sinus access is dependent on the operator s skill, knowledge of the coronary sinus anatomy, and favorable tributaries for safe, reliable placement. Coronary sinus os localization is much easier with a guiding catheter delivery system. The operator simply selects the guiding... 

With the guide catheter safely positioned in the coronary sinus and the target coronary sinus tributary identified, the coronary sinus lead can be placed. If a stylet-driven approach is used, success depends on operator experience, skill, coronary sinus anatomy, lead stylet selection and stylet management. Stylet... 

There is intermittent left ventricular capture noted on the rhythm strip (see Case 37 for further explanation). Given this, it was suspected that the left ventricular lead had become slightly dislodged. In fact, by the next morning the left ventricular lead was noted to be completely dislodged out of the coronary sinus anatomy. 

Fig. 4.71 Heart rotated into the RAO projection with the right atrial cavity exposed demonstrating the superfiscial and deep anatomy of the right heart in relationship to the coronary sinus and its branch tributaries, (from Belott PH Implantation Techniques for Cardiac resynchronization Therapy Barold SS, Mugica J Fifth Decade of Cardiac...

Fig. 4.73 The landmarks of the triangle of Koch are superimposed on the exposed right atrial cavity. The relationship of these structural landmarks to the coronary sinus is seen, (from Ho S Understanding arial anatomy Implications for atrial fibrillation ablation. In Cardiology International for a global perspective on cardiac care. London, Greycoat Publishing 2002. pp sl7-s20)...

Gilard M, Mansourati J, EtienneY et al. Angiograhic anatomy of the coronary sinus and its tributaries. PACE 1998 21 2280-2284. 

Fig. 5.1 Anatomy of the Medial Floor of the Right Atrium. To view the medial aspect of the floor of the right atrium, the anterosuperior portion of the tricuspid valve (TV) was resected. The Thebesian valve (ThV) of the coronary sinus (CS), joins posteriorly with the Eustacian valve (EuV) of the inferior vena cava (IVC). In the close-up view, small fenestrations (E) can be seen within the ThV. These fenestrations can impede placement of a long vascular sheath within the coronary sinus if a guide wire were placed through them.

The anatomy of the coronary sinus venous branches warrants review (Fig. 5.2). The coronary sinus typically joins with the great cardiac vein... 

Fig. 5.2 The Schematic of the Anatomy of Coronary Sinus Venous Branches. Appropriate coronary sinus branch vessel targets for left ventricular lead implantation include those supplying the lateral wall of the left ventricle. These include the anterolateral, lateral (or marginal), posterolateral branches, as well as lateral branches of the middle cardiac vein or great cardiac vein. Individual patients rarely have all of these branches, so techniques to implant at any of these locations during difficult cases should be attempted if one target branch is unacceptable.

Fig. 5.9 RAO and LAO images of a coronary sinus occlusive venogram in a postoperative patient demonstrating a large vein of Marshall (arrow) that could have easily been mistaken for the true coronary sinus. Note the complex lateral venous anatomy. Successful lead implantation was achieved in a lateral venous branch.

Should a left ventricular lead be desired to allow for biventricular pacing, it can be placed either within the left ventricular venous anatomy through the coronary sinus (CS) ... 

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