Evaluation of Variants and Anomalies of Thoracic Systemic and Coronary Venous System Using Multi-Detector Computed Tomographic Angiography

Abstract

Background: Multidetector computed tomography (MDCT) coronary angiography is
currently considered the ideal tool to three-dimensionally delineate the thoracic venous
system, including Superior Vena Cava (SVC), Inferior Vena Cava (IVC), and Coronary Venous
System (CVS). Knowledge of systemic venous variants and anomalies prior to surgical or
interventional procedures is important to safely perform the procedure.
Aim: To assess the role of MDCT coronary angiography with multi-planar reformation (MPR)
and three-dimensional (3D) reconstruction in depicting the variants and anomalies of the
thoracic and coronary venous systems before electrophysiological or surgical interventions.
Method: The study was done in the period from June 2019 to February 2020 in Zagazig
university hospitals. Sixty patients were enrolled (60% males and 40% females; mean age:
55.87±12.02 years, range: 26–71 years) who had MDCT coronary angiography using a 128-
slice MDCT scanner (Ingenuity Phillips health care, best Netherlands).
Results: In our study, Coronary Sinus (CS), Anterior Interventricular Vein (AIV), Middle
Cardiac Vein (MCV), and Great Cardiac Vein (GCV) were detected in all cases (100%).
Posterior Vein of the Left Ventricle (PVLV) was seen in 96.7% of patients. Thebesian valve
was depicted in (73%). Coronary venous system variants represent 20% of cases in the form of
(double MCV variants represent 10%, MCV aneurysm represents 3%, and double PVLV variant
represents 3.45%). At the same time, thoracic systemic venous abnormalities represent 50% of
cases in the form of (interruption of IVC with azygos/hemiazygos continuation about 8.3%, IVC
thrombosis about 5.0%, persistent left SVC about 16.7%, SVC thrombosis about 11.7% and SVC
attenuation about 8.3%).
Conclusion: This study showed that MDCT coronary angiography is a non-invasive imaging
modality in depicting the variants and anomalies of the thoracic systemic and coronary
venous system before electrophysiological or surgical interventions.