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Coronary System Tutorial
What is the Coronary System? Importance of the Coronary System Visualization of the Coronary System Biomedical Applications of the Coronary Arterial System Biomedical Applications of the Cardiac Venous System Cardiac Venous Valves

The coronary venous system has been utilized in a variety of ways to enhance cardiac therapies due to the venous system's "dense meshwork with numerous interconnections" and inability to be affected by atherosclerotic disease.(1) Local electrograms recorded from the coronary venous system can indicate various arrhythmias and ablation target sites for left-sided accessory pathways.(2-4) Defibrillation coils implanted within the coronary venous system, and in particular, the posterior interventricular vein or the anterior interventricular vein, can lower defibrillation thresholds significantly.(5,6) The lower thresholds are likely attributable to more efficient transfer of the defibrillation current through the heart.(5) From the coronary venous system, the coronary flow reserve can be determined(4) and coronary perfusion during percutaneous transluminal angioplasty of coronary arteries can be monitored.(7)

Because the coronary venous system is not prone to the effects of atherosclerotic disease, it can serve as an effective conduit for drug delivery or as a coronary artery bypass. Distribution of cardioplegia through the coronary sinus has been proven to be safe and effective in myocardial protection, and even superior to the traditional method of antegrade cardioplegia, especially in patients with coronary artery disease.(4,8) Since restoration of coronary blood flow prior to an acute myocardial infarction can significantly reduce infarct size and improve myocardial function, administration of recombinant tissue-type plasminogen through the coronary venous system resulted in both shorter recovery times and significant reduction in infarct size when compared to intravenous administration.(9) The coronary venous system has been shown to deliver cell therapy directly to the myocardium as a potential treatment for heart failure.(10) A case study demonstrated that a catheter-based system allowed arterialization of a cardiac vein to bypass a totally occluded left anterior descending coronary artery.(11) The coronary venous system is also used as pacing lead implant sites for biventricular pacing or left ventricular pacing.

Implanted Lead

Pacing leads implanted in the LV coronary veins can pace the LV while endocardial leads simultaneously pace the RV. This human heart had a pacing lead implanted in the posterior vein of the left ventricle, in the postero-lateral region of the heart.

 

  1. Mohl W. Basic considerations and techniques in coronary sinus interventions. In: Mohl W, ed. Coronary sinus interventions in cardiac surgery. Austin: R.G. Landes Company; 1994:1-10.
  2. Cappato R, Schluter M, Weiss C, et al. Mapping of the coronary sinus and great cardiac vein using a 2-French electrode catheter and a right femoral approach. J Cardiovasc Electrophysiol. Apr 1997;8(4):371-376.
  3. Stellbrink C, Diem B, Schauerte P, et al. Transcoronary venous radiofrequency catheter ablation of ventricular tachycardia. J Cardiovasc Electrophysiol. Aug 1997;8(8):916-921.
  4. Silver MA, Rowley NE. The functional anatomy of the human coronary sinus. Am Heart J. May 1988;115(5):1080-1084.
  5. Dosdall DJ, Rothe DE, Brandon TA, et al. Effect of rapid biphasic shock subpulse switching on ventricular defibrillation thresholds. J Cardiovasc Electrophysiol. Jul 2004;15(7):802-808.
  6. Huang J, Walcott GP, Killingsworth CR, et al. Effect of electrode location in great cardiac vein on the ventricular defibrillation threshold. Pacing Clin Electrophysiol. Jan 2002;25(1):42-48.
  7. Nitsch J. Continuous monitoring of coronary perfusion during percutaneous transluminal coronary angioplasty of the left anterior descending artery. Journal of Interventional Cardiology. 1989;2:205-210.
  8. Gundry SR. A comparison of retrograde cardioplegia versus antegrade cardioplegia in the presence of coronary artery obstruction. Paper presented at: 66th Annual Scientific Sessions of the American Heart Association, 1982; Dallas, TX.
  9. Miyazaki A, Tadokoro H, Drury JK, et al. Retrograde coronary venous administration of recombinant tissue-type plasminogen activator: a unique and effective approach to coronary artery thrombolysis. J Am Coll Cardiol. Aug 1991;18(2):613-620.
  10. Thompson CA, Nasseri BA, Makower J, et al. Percutaneous transvenous cellular cardiomyoplasty. A novel nonsurgical approach for myocardial cell transplantation. J Am Coll Cardiol. Jun 4 2003;41(11):1964-1971.
  11. Oesterle SN, Reifart N, Hauptmann E, et al. Percutaneous in situ coronary venous arterialization: report of the first human catheter-based coronary artery bypass. Circulation. May 29 2001;103(21):2539-2543.