Venous valves within left ventricular coronary veins
The purpose of this study was to quantify and characterize venous valves within the major left ventricular (LV) veins of human hearts.
Fiberscope cameras were inserted into the coronary sinus and were manipulated to major LV coronary veins of perfusion fixed human hearts (n = 26). Observed venous valves were categorized by type and location and compared among the major LV veins.
Discernible venous valves were present in 23 of 26 examined hearts (89%); altogether, 105 valves were identified. Sixty-one of the valves were observed at the ostia to smaller branch veins (58% of all valves observed).
Coronary venous valves could hinder or aid in the advancement of guide wires, catheters, and/or the placement of leads for a variety of cardiac interventional procedures. The characterization and quantification of venous valves could explain the difficulty or success in accessing targeted coronary venous locations.
KeywordsCoronary veins Left ventricle Valves
The authors would like to sincerely thank LifeSource and the University of Minnesota Anatomy Bequest Program for their assistance with this study and the generous individuals and families who, by donating their hearts for research, made this study possible. We would also like to thank Gary Williams for his assistance with the figures and video compilation and Monica Mahre for her assistance with the preparation of this manuscript. This work was supported in part by the Institute for Engineering in Medicine at the University of Minnesota and by Medtronic.
The video is organized by vein: anterior interventricular veins, great cardiac veins, posterior veins of the left ventricle, and posterior interventricular veins. At the beginning of each vein, a figure shows its anatomical location. Still images with each representative valve color highlighted aid visualization in subsequent video footage (MPG 19.00 MB)
- 1.Arbelo, E., Caballero, E., Garcia, A., Delgado, A., Amador, C., Melian, F., et al. (2006). Abstract 2886: The anatomy of the coronary venous system: A major determinant for cardiac resynchronization. Circulation, 114(Supplement 18), II_605.Google Scholar
- 2.Blendea, D., Shah, R., Mela, T., Danik, S., Mansour, M., Heist, E. K., et al. (2006). Abstract 2887: The best angiographic view for left ventricular lead placement is highly variable between patients: A rotational coronary venography study. Circulation, 114(Supplement 18), II_605.Google Scholar
- 4.Van De Veire, N. R., Bleeker, G. B., De Sutter, J., Ypenburg, C., Holman, E. R., van der Wall, E. E., et al. (2006). Abstract 2139: Tissue synchronization imaging accurately measures left ventricular dyssynchrony and predicts response to cardiac resynchronization therapy. Circulation, 114(Supplement 18), II_434.Google Scholar
- 5.Hsing, J. M., Grimm, R. A., Garcia, M. J., Martin, D. O., Saliba, W. I., Tchou, P. J., et al. (2006). Abstract 3187: MSCT Coronary venous anatomy is comparable to direct angiographic venous anatomy in identifying suitable coronary veins for cardiac resynchronization therapy. Circulation, 114(Supplement 18), II_675.Google Scholar
- 8.von Ludinghausen, M. (2003). The venous drainage of the human myocardium. Advances in Anatomy, Embryology, and Cell Biology, 168(I–VIII), 1–104.Google Scholar
- 19.Albertsen, A. E., Nielsen, J. C., Pedersen, A. K., Hansen, P. S., Jensen, H. K., & Mortensen, P. T. (2005). Left ventricular lead performance in cardiac resynchronization therapy: Impact of lead localization and complications. Pacing and Clinical Electrophysiology, 28(6), 483–488.PubMedCrossRefGoogle Scholar
- 20.Alonso, C., Leclercq, C., d’Allonnes, F. R., Pavin, D., Victor, R., Mabo, P., et al. (2001). Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: Technical aspects. Heart, 86(4), 405–410.PubMedCrossRefGoogle Scholar
- 25.Macias, A., Gavira, J. J., Alegria, E., Azcarate, P. M., Barba, J., & Garcia-Bolao, I. (2004). Effect of the left ventricular pacing site on echocardiographic parameters of ventricular dyssynchrony in patients receiving cardiac resynchronization therapy. Revista Espanola de Cardiologia, 57(2), 138–145.PubMedCrossRefGoogle Scholar
- 27.Rossillo, A., Verma, A., Saad, E. B., Corrado, A., Gasparini, G., Marrouche, N. F., et al. (2004). Impact of coronary sinus lead position on biventricular pacing: Mortality and echocardiographic evaluation during long-term follow-up. Journal of Cardiovascular Electrophysiology, 15(10), 1120–1125.PubMedCrossRefGoogle Scholar
- 30.Coatrieux, J. L., Hernandez, A. I., Mabo, P., et al. (2005). Transvenous path finding in cardiac resynchronization therapy. Functional Imaging and Modeling of Heart Proceedings, 3504, 236–245.Google Scholar