Imaging of the coronary venous system in patients with congestive heart failure: comparison of 16 slice MSCT and retrograde coronary sinus venography

Comparative imaging of coronary venous system
  • Christian Knackstedt
  • Georg Mühlenbruch
  • Karl Mischke
  • Thomas Schimpf
  • Elmar Spüntrup
  • Rolf W. Günther
  • Beyhan Sanli
  • Malte Kelm
  • Patrick Schauerte
  • Andreas H. Mahnken
Original Paper


Background Knowledge of the anatomy of the coronary venous system (CVS) is important for planning of cardiac interventions like cardiac resynchronization therapy or percutaneus mitral annuloplasty. Different methods have been used for preprocedural visualization of the CVS. However, limited data is available comparing invasive retrograde coronary sinus angiography (CSA) and non-invasive multi slice computed tomography (MSCT). Thus, a comparison of retrograde CSA and ECG-gated MSCT for the visualization of the CVS in patients with congestive heart failure (CHF) was performed. Methods 20 patients (male: 11) with CHF underwent CSA and MSCT (16 × 0.75 mm collimation, tube voltage: 120 kV, tube current: 550 mAseff). Both methods were compared with respect to vessel diameter and visibility. Results Vessel visualization was better using retrograde CSA except for middle cardiac vein and small veins which were better seen with MSCT. Overall, there was a trend that MSCT detected more vessels. Vessel diameters were larger measured using retrograde CSA, but only statistically significant for the coronary sinus and middle cardiac vein. Conclusion Whereas MSCT is more suitable for an overview, retrograde CSA offers a more detailed visualization of the CVS including marginal and posterior veins than MSCT. Thus, retrograde CSA allows a better display of target vessels commonly used for cardiac interventions. Overall, these two imaging techniques offer complementary information.


Congestive heart failure Coronary sinus angiography Coronary venous system MSCT 



Congestive heart failure


Cardiac resynchronization therapy


Coronary sinus


Coronary sinus angiography


Computed tomography


Coronary venous system


Implantable cardioverter defibrillator


Multi slice computed tomography


  1. 1.
    Gerber T, Kantor B, Keelan P et al (2000) The coronary venous system: an alternate portal to the myocardium for diagnostic and therapeutic procedures in invasive cardiology. Curr Interv Cardiol Rep 2:27–37PubMedGoogle Scholar
  2. 2.
    Kar S, Nordlander R (1992) Coronary veins: an alternate route to ischemic myocardium. Heart Lung 21:148–157PubMedGoogle Scholar
  3. 3.
    Ryden L, Tadokoro H, Sjoquist PO et al (1991) Pharmacokinetic analysis of coronary venous retroinfusion: a comparison with anterograde coronary artery drug administration using metoprolol as a tracer. J Am Coll Cardiol 18:603–612PubMedCrossRefGoogle Scholar
  4. 4.
    Kadish A, Mehra M (2005) Heart failure devices: implantable cardioverter-defibrillators and biventricular pacing therapy. Circulation 111:3327–3335. doi: 10.1161/CIRCULATIONAHA.104.481267 PubMedCrossRefGoogle Scholar
  5. 5.
    Webb JG, Harnek J, Munt BI et al (2006) Percutaneous transvenous mitral annuloplasty: initial human experience with device implantation in the coronary sinus. Circulation 113:851–855. doi: 10.1161/CIRCULATIONAHA.105.591602 PubMedCrossRefGoogle Scholar
  6. 6.
    De Martino G, Messano L, Santamaria M et al (2005) A randomized evaluation of different approaches to coronary sinus venography during biventricular pacemaker implants. Europace 7:73–76. doi: 10.1016/j.eupc.2004.09.006 PubMedCrossRefGoogle Scholar
  7. 7.
    Mischke K, Knackstedt C, Mühlenbruch G et al (2007) Imaging of the coronary venous system: retrograde coronary sinus angiography versus venous phase coronary angiograms. Int J Cardiol 119:339–343. doi: 10.1016/j.ijcard.2006.07.148 PubMedCrossRefGoogle Scholar
  8. 8.
    Gerber TC, Sheedy PF, Bell MR et al (2001) Evaluation of the coronary venous system using electron beam computed tomography. Int J Cardiovasc Imaging 17:65–75. doi: 10.1023/A:1010692103831 PubMedCrossRefGoogle Scholar
  9. 9.
    Muhlenbruch G, Koos R, Wildberger JE et al (2005) Imaging of the cardiac venous system: comparison of MSCT and conventional angiography. AJR Am J Roentgenol 185:1252–1257. doi: 10.2214/AJR.04.1231 PubMedCrossRefGoogle Scholar
  10. 10.
    Abbara S, Cury RC, Nieman K et al (2005) Noninvasive evaluation of cardiac veins with 16-MSCT angiography. AJR Am J Roentgenol 185:1001–1006. doi: 10.2214/AJR.04.1382 PubMedCrossRefGoogle Scholar
  11. 11.
    Mao S, Shinbane JS, Girsky MJ et al (2005) Coronary venous imaging with electron beam computed tomographic angiography: three-dimensional mapping and relationship with coronary arteries. Am Heart J 150:315–322. doi: 10.1016/j.ahj.2004.09.050 PubMedCrossRefGoogle Scholar
  12. 12.
    Singh JP, Houser S, Heist EK et al (2005) The coronary venous anatomy: a segmental approach to aid cardiac resynchronization therapy. J Am Coll Cardiol 46:68–74. doi: 10.1016/j.jacc.2005.04.017 PubMedCrossRefGoogle Scholar
  13. 13.
    Vaseghi M, Cesario DA, Ji S et al (2005) Beyond coronary sinus angiography: the value of coronary arteriography and identification of the pericardiophrenic vein during left ventricular lead placement. Pacing Clin Electrophysiol 28:185–190. doi: 10.1111/j.1540-8159.2005.09548.x PubMedCrossRefGoogle Scholar
  14. 14.
    Sra J, Krum D, Okerlund D et al (2004) Three-dimensional and endocardial imaging of the coronary sinus for cardiac resynchronization therapy. J Cardiovasc Electrophysiol 15:1109. doi: 10.1046/j.1540-8167.2004.04037.x PubMedCrossRefGoogle Scholar
  15. 15.
    Mansour M, Rasche V, Picard MH et al (2006) Integration of three-dimensional coronary venous angiography with three-dimensional echocardiography for biventricular device implantation. Heart Rhythm 3:1391–1392. doi: 10.1016/j.hrthm.2006.04.027 PubMedCrossRefGoogle Scholar
  16. 16.
    Mansour M, Reddy VY, Singh J et al (2005) Three-dimensional reconstruction of the coronary sinus using rotational angiography. J Cardiovasc Electrophysiol 16:675–676. doi: 10.1046/j.1540-8167.2005.40752.x PubMedCrossRefGoogle Scholar
  17. 17.
    Van de Veire NR, Schuijf JD, De Sutter J et al (2006) Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography. J Am Coll Cardiol 48:1832–1838. doi: 10.1016/j.jacc.2006.07.042 PubMedCrossRefGoogle Scholar
  18. 18.
    Tops LF, Van de Veire NR, Schuijf JD et al (2007) Noninvasive evaluation of coronary sinus anatomy and its relation to the mitral valve annulus: implications for percutaneous mitral annuloplasty. Circulation 115:1426–1432. doi: 10.1161/CIRCULATIONAHA.106.677880 PubMedCrossRefGoogle Scholar
  19. 19.
    Schaffler GJ, Groell R, Peichel KH et al (2000) Imaging the coronary venous drainage system using electron-beam CT. Surg Radiol Anat 22:35–39. doi: 10.1007/s00276-000-0035-1 PubMedCrossRefGoogle Scholar
  20. 20.
    Stamm G, Nagel HD (2002) CT-expo—a novel program for dose evaluation in CT. Rofo 174:1570–1576PubMedGoogle Scholar
  21. 21.
    Gosch D, Gosch K, Kahn T (2007) Conversion coefficients for estimation of effective dose to patients from dose area product during fluoroscopy X-ray examinations. Rofo 179:1035–1042PubMedGoogle Scholar
  22. 22.
    Husmann H, Alkadhi H, Boehm T et al (2006) Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography. Eur Radiol 16:1111–1116. doi: 10.1007/s00330-005-0110-4 PubMedCrossRefGoogle Scholar
  23. 23.
    Helm RH, Byrne M, Helm PA et al (2007) Three-dimensional mapping of optimal left ventricular pacing site for cardiac resynchronization. Circulation 115:953–961. doi: 10.1161/CIRCULATIONAHA.106.643718 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2008

Authors and Affiliations

  • Christian Knackstedt
    • 1
  • Georg Mühlenbruch
    • 2
  • Karl Mischke
    • 1
  • Thomas Schimpf
    • 1
  • Elmar Spüntrup
    • 2
  • Rolf W. Günther
    • 2
  • Beyhan Sanli
    • 2
  • Malte Kelm
    • 1
  • Patrick Schauerte
    • 1
  • Andreas H. Mahnken
    • 2
  1. 1.Department of Cardiology, Pneumology, Vascular Medicine, University HospitalRWTH Aachen UniversityAachenGermany
  2. 2.Department of Diagnostic Radiology, University HospitalRWTH Aachen UniversityAachenGermany

Personalised recommendations