Abstract
The success of biventricular pacing procedures is at least partially related to the ability to implant leads into the heart. Lead placement into the coronary sinus can be particularly challenging because of variations in the coronary venous anatomy. We examined the anatomy of the coronary sinus and the Thebesian valve. Forty-three (22 male, 21 female) embalmed adult cadavers were used to determine the internal diameter of the coronary sinus ostium, the presence of a membranous or fenestrated Thebesian valve, and the percent occlusion of the coronary sinus ostium by the Thebesian valve, if present. An 8-French (F) guiding catheter was used to simulate coronary sinus cannulation. The average internal diameter of the coronary sinus ostium was 11.44 ± 3.21 mm. A Thebesian valve was present in 74 % of the cadavers, and the majority (84 %) of those valves were membranous. In the presence of a Thebesian valve, the opening at the ostium was reduced to 7.47 ± 2.69 mm. The percent occlusion of the coronary sinus ostium by the Thebesian valve varied from 8.26 to 100 %. The average cannulation distance (length of catheter travel into the coronary sinus from the coronary sinus ostium) was 69 ± 18 mm. Statistical analyses revealed no gender differences in the measurement data for either the coronary sinus or Thebesian valve. The most common presentation is a membranous Thebesian valve. Most frequently, the percent occlusion ranged between 41 and 50 %. The cannulation distance was greater in males than in females.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anh DJ, Eversull CS, Chen HA et al (2008) Characterization of human coronary sinus valves by direct visualization during biventricular pacemaker implantation. Pacing Clin Electrophysiol 31:78–82
Duckett SG, Ginks MR, Knowles BR et al (2011) Advanced image fusion to overlay coronary sinus anatomy with real-time fluoroscopy to facilitate left ventricular lead implantation in CRT. Pacing Clin Electrophysiol 34:226–234
Felle P, Bannigan JG (1994) Anatomy of the valve of the coronary sinus (thebesian valve). Clin Anat 7:10–12
Ghosh SK, Raheja S, Tuli A (2014) Obstructive Thebesian valve: anatomical study and implcations for invasive cardiologic procedures. Anat Sci Int. 89:85–94
Gray H (1995) Barnes and Noble, New York
Habib A, Lachman N, Christensen KN, Asirvatham SJ (2009) The anatomy of the coronary sinus venous system for the cardiac electrophysiologist. Europace. 11:v15–v21
Hellerstein HK, Orbison JL (1951) Anatomic variations of the orifice of the human coronary sinus. Circulation 3:514–523
Jarcho JA (2006) Biventricular pacing. N Engl J Med 355:288–294
Karaca M, Bilge O, Dinckal MH, Ucerler H (2005) The anatomic barriers in the coronary sinus: implications for clinical procedures. J Interv Card Electrophysiol. 14:89–94
Kautzner J (2009) Thebesian valve: the guard dog to the coronary sinus? Europace. 11:1136–1137
Linzbach AJ (1960) Heart failure from the point of view of quantitative anatomy. Am J Cardiol 5:370–382
Loukas M, Bilinsky S, Bilinsky E, El-Sedfy A, Anderson RH (2009) Cardiac veins: a review of the literature. Clin Anat 22:129–145
Mair H, Sachweh J, Meuris B et al (2005) Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing. Eur J Cardiothorac Surg 27:235–242
Mak GS, Hill AJ, Moisiuc F, Krishnan SC (2009) Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures. Europace. 11:1188–1192
Ogul U, Canbay A, Diker E, Aydogdu S (2010) Long Eustachian valve interfering with the access to coronary sinus during biventricular pacemaker implantation. Anadolu Kardiyol Derg. 10:185–186
Sadler TW (2004) Langman’s medical embryology. Lippincott Williams & Wilkins, Philadelphia
Tsao HM, Wu MH, Chern MS, et al (2006) Anatomic proximity of the esophagus to the coronary sinus: implication for catheter ablation within the coronary sinus. J Cardiovasc Electrophysiol 17:266–269
Williams PL, Wanvick R, Dyson M, Bannister LH (1989) Gray’s anatomy. Churchill Livingston, London
Acknowledgments
We would like to acknowledge the support of the Anatomy and Cell Biology Department of Temple University School of Medicine, which allowed access to the cadavers used in this study. We would also like to acknowledge Dr. Florin Deger, Associate Professor of Temple University School of Medicine, Department of Cardiology, for providing us with the guiding catheter for use during our simulated cannulation of the coronary sinus and Dr. Mary Barbe for her review of the manuscript and aid with the figures. Additionally, we would like to thank those who donated their bodies through the Humanity Gift Registry of the Commonwealth of Pennsylvania. Without their donation, our study would not have been possible.
Conflict of interest
The authors do not have any conflicts of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Verenna, AM.A., Heckman, J.L. & Pearson, H.E. Variation of anatomical structures related to biventricular pacing procedures and cannulation of the coronary sinus. Anat Sci Int 91, 169–174 (2016). https://doi.org/10.1007/s12565-015-0281-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12565-015-0281-2