Skip to main content
Top
Published in: Insights into Imaging 5/2014

Open Access 01-10-2014 | Pictorial Review

Computed Tomography and Magnetic Resonance Imaging of the Coronary Sinus: Anatomic Variants and Congenital Anomalies

Authors: Yingming Amy Chen, Elsie T. Nguyen, Carole Dennie, Rachel M. Wald, Andrew M. Crean, Shi-Joon Yoo, Laura Jimenez-Juan

Published in: Insights into Imaging | Issue 5/2014

Login to get access

Abstract

The coronary sinus (CS) is an important vascular structure that allows for access into the coronary veins in multiple interventional cardiology procedures, including catheter ablation of arrhythmias, pacemaker implantation and retrograde cardioplegia. The success of these procedures is facilitated by the knowledge of the CS anatomy, in particular the recognition of its variants and anomalies. This pictorial essay reviews the spectrum of CS anomalies, with particular attention to the distinction between clinically benign variants and life-threatening defects. Emphasis will be placed on the important role of cardiac CT and cardiovascular magnetic resonance in providing detailed anatomic and functional information of the CS and its relationship to surrounding cardiac structures.
Teaching Points
Cardiac CT and cardiovascular magnetic resonance offer 3D high-resolution mapping of the coronary sinus in pre-surgical planning.
Congenital coronary sinus enlargement occurs in the presence or absence of a left-to-right shunt.
Lack of recognition of coronary sinus anomalies can lead to adverse outcomes in cardiac procedures.
In coronary sinus ostial atresia, coronary venous drainage to the atria occurs via Thebesian or septal veins.
Coronary sinus diverticulum is a congenital outpouching of the coronary sinus and may predispose to cardiac arrhythmias.
Literature
1.
go back to reference Mak GS, Hill AJ, Moisiuc F, Krishnan SC (2009) Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures. Europace 11(9):1188–1192PubMedCrossRef Mak GS, Hill AJ, Moisiuc F, Krishnan SC (2009) Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures. Europace 11(9):1188–1192PubMedCrossRef
2.
go back to reference Von Lüdinghausen M (2003) The venous drainage of the human myocardium. Adv Anat Embryol Cell Biol 168:I–VIII, 1–104 Von Lüdinghausen M (2003) The venous drainage of the human myocardium. Adv Anat Embryol Cell Biol 168:I–VIII, 1–104
3.
go back to reference Echeverri D, Cabrales J, Jimenez A (2013) Myocardial venous drainage: from anatomy to clinical use. J Invasive Cardiol 25(2):98–105PubMed Echeverri D, Cabrales J, Jimenez A (2013) Myocardial venous drainage: from anatomy to clinical use. J Invasive Cardiol 25(2):98–105PubMed
4.
go back to reference Recupero A, Pugliatti P, Rizzo F, Carerj S, Cavalli G, de Gregorio C et al (2007) Persistent left-sided superior vena cava: integrated noninvasive diagnosis. Echocardiography 24(9):982–986PubMedCrossRef Recupero A, Pugliatti P, Rizzo F, Carerj S, Cavalli G, de Gregorio C et al (2007) Persistent left-sided superior vena cava: integrated noninvasive diagnosis. Echocardiography 24(9):982–986PubMedCrossRef
5.
go back to reference Shah SS, Teague SD, Lu JC, Dorfman AL, Kazerooni EA, Agarwal PP (2012) Imaging of the coronary sinus: normal anatomy and congenital abnormalities. Radiographics 32(4):991–1008PubMedCrossRef Shah SS, Teague SD, Lu JC, Dorfman AL, Kazerooni EA, Agarwal PP (2012) Imaging of the coronary sinus: normal anatomy and congenital abnormalities. Radiographics 32(4):991–1008PubMedCrossRef
6.
go back to reference Nezafat R, Han Y, Peters DC, Herzka DA, Wylie JV, Goddu B et al (2007) Coronary magnetic resonance vein imaging: imaging contrast, sequence, and timing. Magn Reson Med 58(6):1196–1206PubMedCrossRef Nezafat R, Han Y, Peters DC, Herzka DA, Wylie JV, Goddu B et al (2007) Coronary magnetic resonance vein imaging: imaging contrast, sequence, and timing. Magn Reson Med 58(6):1196–1206PubMedCrossRef
7.
go back to reference Varghese A, Keegan J, Pennell DJ (2005) Cardiovascular magnetic resonance of anomalous coronary arteries. Coron Artery Dis 16(6):355–364PubMedCrossRef Varghese A, Keegan J, Pennell DJ (2005) Cardiovascular magnetic resonance of anomalous coronary arteries. Coron Artery Dis 16(6):355–364PubMedCrossRef
8.
go back to reference Younger JF, Plein S, Crean A, Ball SG, Greenwood JP (2009) Visualization of coronary venous anatomy by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 11:26PubMedPubMedCentralCrossRef Younger JF, Plein S, Crean A, Ball SG, Greenwood JP (2009) Visualization of coronary venous anatomy by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 11:26PubMedPubMedCentralCrossRef
9.
go back to reference Young PM, McGee KP, Pieper MS, Binkovitz LA, Matsumoto JM, Kolbe AB et al (2013) Tips and tricks for MR angiography of pediatric and adult congenital cardiovascular diseases. AJR Am J Roentgenol 200(5):980–988PubMedCrossRef Young PM, McGee KP, Pieper MS, Binkovitz LA, Matsumoto JM, Kolbe AB et al (2013) Tips and tricks for MR angiography of pediatric and adult congenital cardiovascular diseases. AJR Am J Roentgenol 200(5):980–988PubMedCrossRef
10.
go back to reference Mantini E, Grondin CM, Lillehei CW, Edwards JE (1966) Congenital anomalies involving the coronary sinus. Circulation 33(2):317–327CrossRef Mantini E, Grondin CM, Lillehei CW, Edwards JE (1966) Congenital anomalies involving the coronary sinus. Circulation 33(2):317–327CrossRef
11.
go back to reference Yuce M, Kizilkan N, Kus E, Davutoglu V, Sari I (2011) Giant coronary sinus and absent right superior vena cava. VASA 40(1):65–67PubMedCrossRef Yuce M, Kizilkan N, Kus E, Davutoglu V, Sari I (2011) Giant coronary sinus and absent right superior vena cava. VASA 40(1):65–67PubMedCrossRef
12.
go back to reference Jacob M, Sokoll A, Mannherz HG (2010) A case of persistent left and absent right superior caval vein: An anatomical and embryological perspective. Clin Anat 23(3):277–286PubMed Jacob M, Sokoll A, Mannherz HG (2010) A case of persistent left and absent right superior caval vein: An anatomical and embryological perspective. Clin Anat 23(3):277–286PubMed
13.
go back to reference Kula S, Cevik A, Sanli C, Pektas A, Tunaoglu FS, Oguz AD et al (2011) Persistent left superior vena cava: experience of a tertiary health-care center. Pediatr Int 53(6):1066–1069PubMedCrossRef Kula S, Cevik A, Sanli C, Pektas A, Tunaoglu FS, Oguz AD et al (2011) Persistent left superior vena cava: experience of a tertiary health-care center. Pediatr Int 53(6):1066–1069PubMedCrossRef
14.
go back to reference Dong J, Zrenner B, Schmitt C (2002) Images in cardiology: Existence of muscles surrounding the persistent left superior vena cava demonstrated by electroanatomic mapping. Heart 88(1):4PubMedPubMedCentralCrossRef Dong J, Zrenner B, Schmitt C (2002) Images in cardiology: Existence of muscles surrounding the persistent left superior vena cava demonstrated by electroanatomic mapping. Heart 88(1):4PubMedPubMedCentralCrossRef
15.
go back to reference Raj V, Joshi S, Ho YC, Kilner PJ (2010) Case report: Completely unroofed coronary sinus with a left superior vena cava draining into the left atrium studied by cardiovascular magnetic resonance. Indian J Radiol Imaging 20(3):215–217PubMedPubMedCentralCrossRef Raj V, Joshi S, Ho YC, Kilner PJ (2010) Case report: Completely unroofed coronary sinus with a left superior vena cava draining into the left atrium studied by cardiovascular magnetic resonance. Indian J Radiol Imaging 20(3):215–217PubMedPubMedCentralCrossRef
16.
go back to reference Freedom RM, Culham JA, Rowe RD (1981) Left atrial to coronary sinus fenestration (partially unroofed coronary sinus). Morphological and angiocardiographic observations. Br Heart J 46(1):63–68PubMedPubMedCentralCrossRef Freedom RM, Culham JA, Rowe RD (1981) Left atrial to coronary sinus fenestration (partially unroofed coronary sinus). Morphological and angiocardiographic observations. Br Heart J 46(1):63–68PubMedPubMedCentralCrossRef
17.
go back to reference Lee M-S, Pande RL, Rao B, Landzberg MJ, Kwong RY (2011) Cerebral abscess due to persistent left superior vena cava draining into the left atrium. Circulation 124(21):2362–2364PubMedCrossRef Lee M-S, Pande RL, Rao B, Landzberg MJ, Kwong RY (2011) Cerebral abscess due to persistent left superior vena cava draining into the left atrium. Circulation 124(21):2362–2364PubMedCrossRef
18.
go back to reference Benson RE, Songrug T (2009) CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect. Br J Radiol 82(983):e235–e239PubMedCrossRef Benson RE, Songrug T (2009) CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect. Br J Radiol 82(983):e235–e239PubMedCrossRef
19.
go back to reference Raghib G, Ruttenberg HD, Anderson RC, Amplatz K, Adams P, Edwards JE (1965) Termination of left superior vena cava in left atrium, atrial septal defect, and absence of coronary sinus: a developmental complex. Circulation 31(6):906–918PubMedCrossRef Raghib G, Ruttenberg HD, Anderson RC, Amplatz K, Adams P, Edwards JE (1965) Termination of left superior vena cava in left atrium, atrial septal defect, and absence of coronary sinus: a developmental complex. Circulation 31(6):906–918PubMedCrossRef
20.
go back to reference Al-Naami GH, Al-Mesned AA (2009) Total anomalous pulmonary venous drainage to coronary sinus combined with left-sided obstructive lesions: a previously unreported association. Congenit Heart Dis 4(6):469–473PubMedCrossRef Al-Naami GH, Al-Mesned AA (2009) Total anomalous pulmonary venous drainage to coronary sinus combined with left-sided obstructive lesions: a previously unreported association. Congenit Heart Dis 4(6):469–473PubMedCrossRef
21.
go back to reference Tachibana K, Takagi N, Osawa H, Takamuro M, Yokozawa M, Tomita H et al (2007) Cor triatriatum and total anomalous pulmonary venous connection to the coronary sinus. J Thorac Cardiovasc Surg 134(4):1067–1069PubMedCrossRef Tachibana K, Takagi N, Osawa H, Takamuro M, Yokozawa M, Tomita H et al (2007) Cor triatriatum and total anomalous pulmonary venous connection to the coronary sinus. J Thorac Cardiovasc Surg 134(4):1067–1069PubMedCrossRef
22.
go back to reference Mitropoulos F, Samanidis G, Kalogris P, Michalis A (2011) Tortuous right coronary artery to coronary sinus fistula. Interact Cardiovasc Thorac Surg 13(6):672–674PubMedCrossRef Mitropoulos F, Samanidis G, Kalogris P, Michalis A (2011) Tortuous right coronary artery to coronary sinus fistula. Interact Cardiovasc Thorac Surg 13(6):672–674PubMedCrossRef
23.
go back to reference Said SAM, van der Sluis A, Koster K, Sie H, Shahin GMM (2010) Congenital circumflex artery-coronary sinus fistula in an adult female associated with severe mitral regurgitation and myelodysplasy–case report and review of the literature. Congenit Heart Dis 5(6):599–606PubMedCrossRef Said SAM, van der Sluis A, Koster K, Sie H, Shahin GMM (2010) Congenital circumflex artery-coronary sinus fistula in an adult female associated with severe mitral regurgitation and myelodysplasy–case report and review of the literature. Congenit Heart Dis 5(6):599–606PubMedCrossRef
24.
go back to reference Hajj-Chahine J, Belmonte R, Lefant P-Y, Tomasi J (2011) eComment: Cardioplegia in coronary artery fistula to coronary sinus. Interact Cardiovasc Thorac Surg 13(6):675PubMedCrossRef Hajj-Chahine J, Belmonte R, Lefant P-Y, Tomasi J (2011) eComment: Cardioplegia in coronary artery fistula to coronary sinus. Interact Cardiovasc Thorac Surg 13(6):675PubMedCrossRef
25.
go back to reference Shum JSF, Kim SM, Choe YH (2012) Multidetector CT and MRI of ostial atresia of the coronary sinus, associated collateral venous pathways and cardiac anomalies. Clin Radiol 67(12):e47–e52PubMedCrossRef Shum JSF, Kim SM, Choe YH (2012) Multidetector CT and MRI of ostial atresia of the coronary sinus, associated collateral venous pathways and cardiac anomalies. Clin Radiol 67(12):e47–e52PubMedCrossRef
26.
go back to reference Santoscoy R, Walters HL, Ross RD, Lyons JM, Hakimi M (1996) Coronary sinus ostial atresia with persistent left superior vena cava. Ann Thorac Surg 61(3):879–882PubMedCrossRef Santoscoy R, Walters HL, Ross RD, Lyons JM, Hakimi M (1996) Coronary sinus ostial atresia with persistent left superior vena cava. Ann Thorac Surg 61(3):879–882PubMedCrossRef
27.
go back to reference Fulton JO, Mas C, Brizard CPR, Karl TR (1998) The surgical importance of coronary sinus orifice atresia. Ann Thorac Surg 66(6):2112–2114PubMedCrossRef Fulton JO, Mas C, Brizard CPR, Karl TR (1998) The surgical importance of coronary sinus orifice atresia. Ann Thorac Surg 66(6):2112–2114PubMedCrossRef
28.
go back to reference Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M (2004) Venous anomalies of the thorax. AJR 182(5):1139–1150PubMedCrossRef Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M (2004) Venous anomalies of the thorax. AJR 182(5):1139–1150PubMedCrossRef
30.
go back to reference Funabashi N, Asano M, Komuro I (2006) Giant coronary sinus diverticulum with persistent left superior vena cava demonstrated by multislice computed tomography. Int J Cardiol 111(3):468–469PubMedCrossRef Funabashi N, Asano M, Komuro I (2006) Giant coronary sinus diverticulum with persistent left superior vena cava demonstrated by multislice computed tomography. Int J Cardiol 111(3):468–469PubMedCrossRef
31.
go back to reference Mandegar MH, Saidi B, Oraii S, Tehrai M, Roshanali F (2011) Giant diverticulum causing ventricular arrhythmia. J Card Surg 26(1):117–118PubMedCrossRef Mandegar MH, Saidi B, Oraii S, Tehrai M, Roshanali F (2011) Giant diverticulum causing ventricular arrhythmia. J Card Surg 26(1):117–118PubMedCrossRef
32.
go back to reference Saremi F, Muresian H, Sánchez-Quintana D (2012) Coronary veins: comprehensive CT-anatomic classification and review of variants and clinical implications. Radiographics 32(1):E1–E32PubMedCrossRef Saremi F, Muresian H, Sánchez-Quintana D (2012) Coronary veins: comprehensive CT-anatomic classification and review of variants and clinical implications. Radiographics 32(1):E1–E32PubMedCrossRef
33.
go back to reference Tham EBC, Ross DB, Giuffre M, Smallhorn J, Noga ML (2007) Cardiac magnetic resonance imaging of a coronary sinus diverticulum associated with congenital heart disease. Circulation 116(21):e541–e544PubMedCrossRef Tham EBC, Ross DB, Giuffre M, Smallhorn J, Noga ML (2007) Cardiac magnetic resonance imaging of a coronary sinus diverticulum associated with congenital heart disease. Circulation 116(21):e541–e544PubMedCrossRef
Metadata
Title
Computed Tomography and Magnetic Resonance Imaging of the Coronary Sinus: Anatomic Variants and Congenital Anomalies
Authors
Yingming Amy Chen
Elsie T. Nguyen
Carole Dennie
Rachel M. Wald
Andrew M. Crean
Shi-Joon Yoo
Laura Jimenez-Juan
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 5/2014
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-014-0330-8

Other articles of this Issue 5/2014

Insights into Imaging 5/2014 Go to the issue