ANATOMICAL VARIABILITY OF THE LEFT LOWER PHRENIC VEIN AND CORONARY SINUS IN THE APPLICATION VALVES OF INTERVENTIONAL ARRHYTHMOLOGY

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Aim. Study of variants of the structure of the coronary sinus valves and the left inferior phrenic vein in the aspect of interventional arrhythmology. Material and Methods. We studied 30 preparations of hearts, 120 preparations of veins of the diaphragm of people, died at the age of 22 to 75 years and phlebograms of the left lower phrenic vein in 30 patients of both sexes of the same age. Sectional, injection, angiographic and statistical methods of investigation were used. Results and Discussion. The valve of the coronary sinus was revealed in 70% of cases (21/30), in 30% (9/30) the flap was absent. Catheterized coronary sinus valves were found in 80% (17/21) or 57% (17/30) of all observations. Thus, in 87% (26/30) cases, catheterization is possible, and for 13% (4/30), an alternative route is needed for the left ventricular electrode. As an alternative, the left lower phrenic vein flowing into the inferior vena cava in 60% of cases (72/120) are considered. Free are catheterized with a diameter of 5 mm or more - in 36.6% of cases (44/72) and conditionally catheterized with a diameter of less than 5 mm - in 23.3% of cases (28/72). Venous sinus as the main way of implantation of the left ventricular electrode with cardiac resynchronization therapy can be suitable for catheterization in 87% of patients, and for 13% of patients an alternative way of its implementation is needed. The left inferior phrenic vein, which flows into the lower vena cava, freely or conditionally catheterized, can serve as such an alternative pathway.