Anatomical Variants of Coronary Venous System on Cardiac Computed Tomography

BACKGROUND: In a few studies, huge anatomical variability of coronary venous system (CVS) has been documented without analysis of its variants. The aim of the present study was to evaluate anatomical variants of CVS in multislice computed tomography (MSCT). METHODS AND RESULTS: In 199 patients (114 males, age 56.6±11.5 years), a 64-slice computed tomography (Aquilion 64) was performed due to coronary artery disease suspicion. A scan with electrocardiogram-gating was performed using a slice thickness of 0.5mm during a breath-hold. In each case, 3D volume rendering and 2D multi-planar reformatting reconstructions of CVS were created (Vitrea 2). As target veins for cardiac resynchronization therapy (CRT), the posterolateral, lateral and anterolateral veins were recognized. Coronary sinus was well visualized in all cases. A total of 27 anatomical variants of CVS were identified, 9 of them are most common (in 148/199 cases; 74.4%). In 4 out of these 9 variants, a single coronary vein in the target area for CRT appeared, 2 target veins in 3 variants and 3 veins in 2 variants occurred. In 6 cases (2 seldom variants-3.0%) no veins in the target area were identified. CONCLUSIONS: In the majority of the examined patients, at least one vein in the target area for CRT was observed. Anatomical variability of CVS strengthen the potential role of MSCT in CVS visualization before CRT implantation.