Coronary Vein Classification with CT

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Cardiac-Interventional Radiography: 4.25
Procedures: 4.25
Diagnostic and Conduction System Studies: 4.25

Computed Tomography: 4.25
Procedures: 4.25
Neck and Chest: 4.25

Nuclear Medicine Technology: 1.50
Procedures: 1.50
Cardiac Procedures: 1.50

Registered Radiologist Assistant: 4.25
Procedures: 4.25
Thoracic Section: 4.25

Outline

1. Introduction
2. Development of the Cardiac Veins
3. Cardiac Vein Classification
4. Lesser CVS (Thebesian Vessels
   1. Conduction System
   2. Papillary Muscles
   3. Venoluminal Thebesian Vessels
5. Atrial Venous System
   1. Veins of the LA Wall
   2. Veins of the RA Wall
6. Anterior Right Ventricular Venous System
   1. Anterior Cardiac Veins
   2. Right Marginal Vein
   3. Conus (Infundibular) Veins
7. CS Tributaries
   1. Imaging Methods
   2. Great Cardiac Vein
   3. Inferior Interventricular Vein
   4. Left Posterior (Postero-lateral) and Left Marginal Veins
   5. Small Cardiac Vein
   6. Oblique Vein of the LA (Vein of Marshall
   7. Ventricular Septal Veins
   8. Valves of Coronary Veins
   9. CS Boundaries
   10. Phasic Variation of the Coronary Veins
8. Coronary Veins and Congenital Heart Disease
   1. Cardiac Resynchronization Therapy
   2. CS Interatrial Muscle Connections
9. Percutaneous Mitral Annuloplasty
10. RCP Delivery from the CS
11. Conclusions

Objectives

Upon completion of this course, students will:

1. understand the role of coronary veins in the treatment of structural heart disease and malignant ventricular tachyarrhythmia
2. understand the importance of cardiac venous mapping prior to an invasive cardiac procedure
3. be familiar with diagnostic imaging procedures used to visualize the cardiac venous system
4. understand the vessels which make up the cardiac circulation
5. be familiar with the various layers of the heart
6. understand the embryological development of the cardiac venous system
7. be familiar with the role the cardinal vein plays in the cardiac venous system’s stages of development
8. be familiar with the two major classes of cardiac veins
9. understand what the term compound cardiac venous system means
10. be familiar with the cardiac venous drainage pathways of the cardiac ventricles and atriums
11. understand the thebesian vessels and their role
12. be familiar with the four distinct parts of the thebesian vessel system
13. understand the meaning of vessel sinusoids
14. understand the role of the sinoatrial node in the cardiac conduction system
15. understand the role of the atrioventricular node in the cardiac conduction system
16. understand the role of the papillary muscles in the cardiac system
17. be familiar with the three main groups of left atrial wall veins and their drainage pathways
18. be familiar with the three main groups of right atrial wall veins and their drainage pathways
19. be familiar with the von Lüdinghausen classification of the cardiac atrial venous system
20. be familiar with the role of the anterior right ventricular cardiac veins and their drainage pathways
21. understand the anatomy that surrounds the coronary sinus
22. understand the role the coronary sinus plays in invasive cardiac interventional procedures
23. understand the role the coronary sinus plays in the cardiac conduction system
24. be familiar with the challenges to imaging the heart using diagnostic procedures
25. be familiar with the contrast injection techniques pertaining to CT angiography
26. understand the advantages of MDCT coronary angiography compared to other procedures
27. understand the disadvantages of MDCT coronary angiography compared to other procedures
28. be familiar with the various planes and projections used with MDCT angiography
29. know why the levophase of coronary venography is important
30. be familiar with dose reduction techniques that may be used in MDCT coronary angiography
31. be familiar with the pre- and post-processing techniques used with MDCT coronary angiography data
32. understand the benefits of volume rendering with MDCT for the cardiac venous system
33. understand the “gold standard” for visualizing the cardiac venous system
34. be familiar with the techniques that are used for retrograde venography
35. identity the standard projections taken during a retrograde venography procedure
36. understand the pitfalls and disadvantages of retrograde venography
37. be familiar with the cardiac veins near the coronary sinus and their role
38. be familiar with the cardiac veins of the walls of the left ventricle and their drainage pathways
39. be familiar with imaging the oblique vein of Marshall
40. be familiar with the various types of venous valves
41. be familiar with the benefits of cardiac resynchronization therapy
42. be familiar with congenital cardiac lesions associated with coronary sinus atresia and a left superior vena cava
43. understand the benefits of percutaneous mitral annuloplasty
44. identify patients who may not be candidates for percutaneous mitral annuloplasty
45. identify the benefits of retrograde cardioplegia perfusion