Contrast venography in the LAO and RAO

Contrast venography in the LAO (A) and RAO (B) projections depicting expected venous branches of the coronary sinus. These images were obtained from a patient with a mechanical mitral valve prosthesis (MV) in order to provide anatomic orientation. These images also demonstrate both pacing and ICD leads fixed in the right ventricular apex. The RAO image also includes the presence of a pacing lead fixed in the right atrial appendage. The anterior interventricular vein (AIV) courses in the interventricular groove between the right and left ventricles. The middle cardiac vein (MCV) courses posteriorly over the left ventricle. Venous branches commonly selected for left ventricular lead placement include (1) the anterolateral branch, (2) the midlateral branch, and (3) the posterolateral branch.