The cardiac veins in congenitally corrected transposition of the great arteries: Delivery options for cardiac devices

Bottega, Natalie A.; Kapa, Suraj; Edwards, William D.; Connolly, Heidi M.; Munger, Thomas M.; Warnes, Carole A.; Asirvatham, Samuel J.

doi:10.1016/j.hrthm.2009.07.037

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Volume 6, Issue 10 , Pages 1450-1456, October 2009

The cardiac veins in congenitally corrected transposition of the great arteries: Delivery options for cardiac devices

Natalie A. Bottega, MD, FRCPC
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
Suraj Kapa, MD
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
William D. Edwards, MD, FACC
- Division of Cardiac Pathology, Mayo Clinic, Rochester, Minnesota
Heidi M. Connolly, MD, FACC
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Thomas M. Munger, MD, FACC
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Carole A. Warnes, MD, FRCP, FACC, FAHA
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Samuel J. Asirvatham, MD, FACC, FHRS
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Address reprint requests and correspondence: Dr. Samuel J. Asirvatham, Division of Cardiovascular Diseases, Department of Internal Medicine and Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905

Received 23 April 2009; accepted 18 July 2009. published online 22 July 2009.

Background

Device implantation is sometimes required in congenitally corrected transposition of the great arteries (ccTGA) because of morphologic right ventricular (RV) dysfunction and complete heart block. The anatomical course of the veins remains unknown, despite well-described coronary arterial anatomy. Knowledge of the venous anatomy may facilitate planning of percutaneous cardiac procedures in these patients.

Objective

This study sought to characterize the venous anatomy in ccTGA.

Methods

Pathologic cardiac specimens from patients with ccTGA were identified from the Mayo Clinic pathology database. Coronary sinus (CS) anatomy and distances from the CS ostium to the major cardiac veins were evaluated. Thebesian veins with ostial openings >1 mm, epicardial veins, and venous collaterals were also quantified.

Results

There were 56 hearts with a diagnosis of ccTGA identified. The CS was unidentifiable in 5 hearts due to slicing, and assessment of the Thebesian veins was not possible in 16. Seven hearts had an abnormal CS, 2 of which had atretic ostia and the other 5 of which either had an abnormal ostial location or multiple ostia. There were 28 hearts with at least 1 Thebesian vein with an ostial opening >1 mm. All 12 hearts with unidentifiable Thebesian veins had venous collaterals from the right ventricle (RV) to the major cardiac veins. Epicardial veins extended to the proximal, middle, and distal thirds of the RV in 71%, 23%, and 6%, respectively.

Conclusion

In ccTGA, the ventricular venous anatomy is abnormal and follows the morphologic RV. However, large interventricular and Thebesian veins may offer options for percutaneous lead or catheter placement when approaching the systemic RV.

Keywords: ccTGA, Cardiac veins, Lead placement

Abbreviations: ccTGA, congenitally corrected transposition of the great arteries, CHD, congenital heart disease, CS, coronary sinus, LV, left ventricle, RA, right atrium, RV, right ventricle