The Valve of Vieussens: An Important Cause of Difficulty in Advancing Catheters into the Cardiac Veins

Abstract

INTRODUCTION: The coronary sinus and cardiac veins are useful conduits for the passage of electrode catheters for mapping the origin of cardiac arrhythmias. However, sometimes it is difficult to advance catheters an adequate distance into the cardiac veins. The aim of this study was to determine the reasons for this. METHODS AND RESULTS: In 50 cadaveric hearts, a deflectable 7-French electrode catheter was passed from the right atrium into the coronary sinus and advanced to the anterior interventricular portion of the great cardiac vein (GCV). Causes of obstruction were determined. The catheter was obstructed by the valve of Vieussens in 23 of 50 hearts (46%). Once the valve was negotiated, obstruction was caused by an acute bend in the GCV in 28 of 50 hearts (56%). Clinical studies were undertaken in 10 patients in whom electrode catheters could not be advanced as far as required. Using contrast venography, the most frequent cause of obstruction was determined to be the valve of Vieussens in 8 of 10 cases (80%). An acute bend in the GCV caused obstruction in 2 cases (20%). CONCLUSIONS: The valve of Vieussens is a frequent cause of obstruction to passage of a catheter in postmortem and in vivo studies. An acute bend in the vein, with or without lodgment in a tributary, is the other common cause. In adults, venous luminal diameter is not a cause of obstruction to the passage of a 7-French catheter in the coronary sinus or proximal GCV.