Coronary sinus tributaries

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... 

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...

Use of the left anterior oblique projection is extremely important in defining the tributaries of the coronary sinus (Fig. 4.76). In the frontal and right anterior oblique projections, tributaries of the coronary sinus appear to run perpendicular to the coronary sinus obliquely from a superior to an inferior direction (Fig. 4.77). The branches appear to be parallel, and differentiation of anteroseptal, lateral, and posterolateral branches is almost impossible. For simplicity and for the purpose of this discussion, branches or tributaries of the coronary sinus are described from their ostia in the coronary sinus. In the LAO projection, the great cardiac vein or anterior cardiac vein comes off of the coronary sinus superiorly into the right. It then turns acutely, descending inferiorly... 

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... 

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

Fig. 18.11 Posteroanterior (A) and lateral (B) chest radiographs demonstrating a ventricular lead that courses posteriorly in the coronary sinus and into a cardiac vein, probably a tributary of the posterior cardiac vein. This determination cannot be made from the posteroanterior view only.

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