Chen Jien-Jiun, Lee Wen-Jeng, Wang Yi-Chih, Tsai Chia-Ti, Lai Ling-Ping, Hwang Juey-Jen, Lin Jiunn-Lee
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
J Card Fail. 2007 Aug;13(6):482-8. doi: 10.1016/j.cardfail.2007.02.007.
Variations of coronary venous system in a dilated, failing heart may well be unpredictable. Noninvasive preview of coronary veins before left ventricular (LV) lead implantation for cardiac resynchronization therapy would facilitate successful procedure in chronic systolic heart failure (SHF) patients.
Multidetector computed tomography (MDCT) of the heart was investigated in 23 consecutive patients of chronic SHF with LV ejection fraction < or = 40%. Morphologic and topologic characteristics of coronary venous system were studied, and compared with 23 age-matched controls. All coronary veins including coronary sinus, posterior interventricular vein (PIV), LV posterior vein, left margin vein (LMV), and anterior interventricular vein (AIV) were clearly visible in all 23 SHF patients and 23 normal controls. Total coronary venous length (ie, from PIV to AIV) was directly correlated with LV volume (r = 0.65, P < .001). The main lengthened venous segment was between LMV and AIV. Ostial diameters of all coronary venous tributaries were larger in SHF patients, but the angle of branching was similar. However, the secondary angle of the coronary sinus relative to superior vena cava axis was more acute (30 +/- 7 degrees) in SHF patients than that in normal (44 +/- 8 degrees, P < .001). Local aneurysm locating at LV posterolateral wall could detour relevant coronary vein tributaries to the outer border of the aneurysm, compress venous dimensions throughout the cardiac cycle, and cause acute angulation of venous tributaries.
Coronary venous system shown by MDCT in SHF patients with low LV ejection fraction manifested longer venous length between LMV and AIV, acute secondary CS angle, and usually topologically distorted by posterolateral LV aneurysms. A panoramic delineation of all coronary venous tributaries could help effective venous intervention.
在扩张的、衰竭的心脏中，冠状静脉系统的变异可能难以预测。在植入左心室（LV）导线进行心脏再同步治疗之前，对冠状静脉进行无创性预评估将有助于慢性收缩性心力衰竭（SHF）患者的手术成功。
对23例连续的慢性SHF患者（左心室射血分数≤40%）进行心脏多排螺旋CT（MDCT）检查。研究冠状静脉系统的形态和拓扑特征，并与23例年龄匹配的对照组进行比较。在所有23例SHF患者和23例正常对照中，所有冠状静脉包括冠状窦、室后静脉（PIV）、左心室后静脉、左缘静脉（LMV）和室前静脉（AIV）均清晰可见。冠状静脉总长度（即从PIV到AIV）与左心室容积直接相关（r = 0.65，P <.001）。主要延长的静脉段位于LMV和AIV之间。SHF患者所有冠状静脉分支的开口直径较大，但分支角度相似。然而，SHF患者冠状窦相对于上腔静脉轴的二级角度比正常患者更尖锐（30±7度）（正常为44±8度，P <.001）。位于左心室后外侧壁的局部动脉瘤可使相关冠状静脉分支绕过动脉瘤的外边界，在整个心动周期中压缩静脉尺寸，并导致静脉分支急性成角。
MDCT显示的低左心室射血分数SHF患者的冠状静脉系统表现为LMV和AIV之间的静脉长度较长，冠状窦二级角度尖锐，并且通常在拓扑结构上被左心室后外侧壁动脉瘤扭曲。对所有冠状静脉分支进行全景描绘有助于有效的静脉干预。
