← All decks
Cardiology
Catheterization of the Cardiac Venous System A Contemporary Perspective
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
6 sections · 93 slides
Overview
- Scope of this topic
- Coronary sinus as an interventional gateway
- Rationale for cardiac resynchronization therapy
Anatomic considerations
- Two interconnecting venous systems
- Thebesian venous system
- Physiologic shunt and territories drained
- Thebesian system as a collateral network
- Clinical relevance of the thebesian network
- The coronary sinus: definition and position
- Coronary sinus dimensions and filling
- Embryology of the coronary sinus
- Wall structure and contractility
- Coronary sinus contractility on arteriography
- Electrical connections of the coronary sinus
- Vein of Marshall and atrial fibrillation
- The Thebesian valve
- The Vieussens valve
- Near-occlusive valve on coronary sinus angiogram
- The coronary sinus ostium
- Atrial venous drainage
- Nomenclature of the left superior vena cava remnant
- Epicardial venous system
- Anterior interventricular vein
- Venous route from apex to right atrium
- Lateral cardiac veins
- Middle cardiac vein
- Posterolateral and middle cardiac veins
- Two semicircles as a frame of reference
- Posterior ventricular vein
- Surface collateral loops
- Epicardial branches and collateral loops of the left ventricle
Imaging and catheterization technique
- Multidetector computed tomography
- Principles of coronary sinus catheterization
- Right atrial landmarks
- Limits of two-dimensional fluoroscopy
- Engaging the coronary sinus ostium
- Direction of rotation and its rationale
- Troubleshooting failed engagement
- Entering the great cardiac vein
- Catheter course into the great cardiac vein
- Crossing the Vieussens valve
- Achieving a stable working position
- Fluoroscopic projections
- Fishbowl model of the left ventricle
- Epicardial veins in three fluoroscopic projections
- Balloon-occlusion venography
- Alternative routes for visualising the sinus
Indications
- Range of coronary sinus interventions
- Electrophysiological applications
- Evidence for cardiac resynchronization therapy
- Coronary sinus Reducer stent
- ORBITA-COSMIC trial findings
- Retrograde drug delivery
- Fibrinolysis by the coronary venous route
- Gene therapy by retrograde venous perfusion
- Angiogenic growth factors
- Percutaneous mitral annuloplasty
- Annuloplasty devices
- Limitations of coronary sinus annuloplasty
- Percutaneous in situ coronary venous arterialization
- Cardiac endoscopy of the coronary sinus
Equipment
- Catheters for coronary sinus cannulation
- Catheters for coronary sinus cannulation
- Deflectable versus fixed-curve catheters
- Telescoping catheter systems
- Cannulation in dilated chambers
Limitations and complications
- Susceptibility of the coronary sinus to injury
- Perforations
- Dissection
- Contrast extravasation
- Management after recognising an injury
- Persistent left superior vena cava
- Unroofed coronary sinus
- Treatment of unroofed coronary sinus
- Coronary sinus diverticulum
- Relative contraindications
- Key points: anatomy
- Key points: technique and complications
- Conclusions
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
- Join our WhatsApp groups