Angiographic assessment of vein of Marshall in atrial fibrillation: Implications for identification and cannulation

Figures

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  Fig. 1. Flow chart of patient enrollment AF, atrial fibrillation; VOM, the vein of Marshall; RAO, right anterior oblique; LAO, left anterior oblique.

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  Fig. 2. The morphology of the VOM in different views A: The VOM could be identified in all three views; B: The VOM could be identified in the RAO and LAO cranial view but is barely seen in the LAO view; C: The VOM could only be identified in the LAO cranial view and is barely seen in the RAO and LAO view; D: The VOM probably exists but is barely seen in all three views; E: The VOM probably does not exist. VOM, the vein of Marshall; RAO, right anterior oblique; LAO, left anterior oblique. The arrow indicates the VOM; The red VOM means the VOM probably exists but is barely seen. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

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  Fig. 3. The angiographic assessment of the VOM in different views. A: The locations of the VOM in the LAO view; B: Detailed measurement of the VOM. VOM, the vein of Marshall; VOMo, VOM ostium; RAO, right anterior oblique; LAO, left anterior oblique; CS, coronary sinus; CSo, CS ostium; MCV, middle cardiac vein; PLV, posterior lateral vein; a, the diameter of VOMo; b, the CS diameter at the VOMo; c, the diameter of CSo; d, the distance from VOMo to CSo; e, the vertical distance of VOMo to the roof of CSo; α, the angle of VOM and CS in the LAO view; β, the angle of VOM and CS in the RAO view. The white arrow indicates VOM; the yellow arrow indicates the valve of Vieussens. The numbers in the pie chart indicate the VOMo clock location along the mitral annulus in the LAO view (LAO cranial view if VOM was not identifiable in the LAO view); VOM 1–4 represents the four hypothetical locations and does not mean four VOMs for one CS. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

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  Fig. 4. The angiographic features in the LAO or LAO cranial view. A: The number of patients in different groups according to the VOM location; B: The cannulation success rates of patients in different groups according to the VOM location; C and D: The cannulation time of patients in different groups according to the VOM location. VOM, the vein of Marshall; LAO, left anterior oblique.

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  Fig. 5. ROC curves of predicting difficult cannulation. A: The predicting value of CSo diameter in the RAO view; B: The predicting value of VOMoClock. ROC, receiver operative characteristic curve; AUC, area under curve; CI, confidential interval; VOM, the vein of Marshall; CSo, coronary sinus ostium; VOMo, VOM ostium; VOMoClock, VOMo location along the mitral annulus in the LAO view (LAO cranial view if VOM was not identifiable in the LAO view).