Coronary venous anatomy

Meisel E, Pfeiffer D Engehnann L et al. Investigation of the coronary venous anatomy by retrograde venography in patients with malignant ventricular tachycardia. Circulation 2001 104 442-7. 

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) ... 

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.

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