Visualization of coronary venous anatomy by cardiovascular magnetic resonance

Thirty-one 3D whole heart CMR studies, performed after intravenous administration of 0.05 mmol/kg gadolinium DTPA, were reviewed. The cardiac venous system was visualized in all patients. The lateral vein of the left ventricle was present in 74%, the anterior interventricular vein in 65%, and the posterior interventricular vein in 74% of patients. The mean maximum distance of demonstrable cardiac vein on the 3D images was 81.5 mm and was dependent on the quality of the 3D data set. Five patients showed evidence of myocardial infarction on late gadolinium enhancement (LGE) images.Coronary venous anatomy can be reliably demonstrated using a comprehensive CMR protocol and a standard extracellular contrast agent. The combination of coronary venous imaging, assessment of ventricular function and LGE may be useful in the management of patients with LV dysfunction being considered for CRT.Cardiac resynchronization therapy (CRT) is now an established treatment for chronic heart failure with broad QRS duration [1]. It requires the deployment of a left ventricular (LV) pacing lead to a branch of the cardiac venous system, usually via the coronary sinus. However this procedure is unsuccessful in 5–12% of patients for a variety of reasons including difficulty accessing the coronary sinus ostium, or lack of a suitable cardiac vein in which to position the LV lead [2]. Prior knowledge of coronary venous anatomy may prove useful to cardiologists both in the selection of patients suitable for CRT and for the guidance of LV lead implantation.Demonstration of cardiac venous anatomy is recognized as an appropriate indication for cardiac CT scanning [3]. Coronary venous imaging with cardiovascular magnetic resonance (CMR) angiography has recently been described; however all previous studies have used either developmental pulse sequences or non-standard, intravascular contrast agents [4-6]. Late gadolinium enhancement (LGE) images, which can provide important complementary information f