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World J Radiol. Jul 28, 2014; 6(7): 399-408
Published online Jul 28, 2014. doi: 10.4329/wjr.v6.i7.399
Coronary venous system in cardiac computer tomography: Visualization, classification and role
Rafal Mlynarski, Agnieszka Mlynarska, Maciej Sosnowski
Rafal Mlynarski, Agnieszka Mlynarska, Maciej Sosnowski, Unit of Noninvasive Cardiovascular Diagnostics, Medical University of Silesia, Upper-Silesian Cardiology Center, Katowice 40-635, Poland
Rafal Mlynarski, Agnieszka Mlynarska, Department of Electrocardiology, Medical University of Silesia, Upper-Silesian Cardiology Center, Katowice 40-635, Poland
Maciej Sosnowski, 2nd Chair and Division of Cardiology, Medical University of Silesia, Upper-Silesian Cardiology Center, Katowice 40-635, Poland
Author contributions: All authors who wrote this paper had substantial contribution to conception and design and final approval of the version to be published.
Correspondence to: Rafal Mlynarski, MD, PhD, Department of Electrocardiology, Medical University of Silesia, Upper-Silesian Cardiology Center, ul. Ziolowa 45/47, Katowice 40-635, Poland. rafal_mlynarski@mp.pl
Telephone: +48-60-6484161 Fax: +48-32-2524098
Received: December 31, 2013
Revised: February 28, 2014
Accepted: May 16, 2014
Published online: July 28, 2014
Processing time: 211 Days and 17.6 Hours
Abstract

The role of the coronary venous system was underestimated for many years. In the last 20 years, a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use. The most important seems to be cardiac resynchronization therapy, which is an invasive method for the treatment of heart failure. Unfortunately, one of the major problems is the significant anatomical variability of the coronary venous system. The description of the selected anatomical structures is only useful in selected cases such as, for example, the obstruction of selected vessels, a huge Thebesian valve, etc. The 3D images can add significant value; however, their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy. After summarizing all of the articles and guidelines, it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization. The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases.

Keywords: Coronary venous system; Coronary sinus; Thebesian valve; Cardiac computed tomography; Cardiac resynchronization therapy; Percutaneous mitral annuloplasty

Core tip: In the article role of the analysis of coronary venous system in cardiac computed tomography (CT) was presented. In the last 20 years, a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use. The description of the selected anatomical structures in CT is useful in selected cases such as, for example, the obstruction of selected coronary veins, a huge Thebesian valve, etc.