ABSTRACT
Background: Knowledge of the coronary sinus venous anatomy is an important factor because of its relevance in electrophysiological procedures such as chronic resynchronisation therapy, mapping and ablation of arrhythmias. The advent of advanced invasive and interventional cardiac treatment and management tools for common disorders like heart failure has made understanding of coronary sinus anatomy necessary. The aim was to study the angiographic anatomy of coronary sinus and its tributaries in adult Kashmiri population and provide anatomical basis for cannulation of coronary sinus and its tributaries.Methods: Authors analysed the levophase angiogram of 150 subjects undergoing routine coronary angiography in the right anterior oblique and left anterior oblique view with the necessary caudal or cranial angulations.Results: The coronary sinus was formed by the union of GCV+LMV in 93.3% of subjects and by the union of GCV+PLV in 6.7% of subjects. The GCV and the MCV were the most consistent tributaries present in all the subjects. The mean length of CS was 71.70±9.7 mm when it was formed by GCV+LMV and 70.18±14.98 mm in case of GCV+PLV. The diameter of the CS ostium was 8.48±1.21mm. The mean diameter of GCV was 2.90±1.24 mm, MCV was 2.76±1.08 mm, LMV was 2.23±0.51 mm and the PLV was 2.25±0.53 mm. The opening angle of GCV was obtuse in all the cases, MCV drained at an acute angle in 62% subjects and LMV draining angle was acute in 31.33% cases. The valve of the CS was present in 32.7% subjects and absent in 67.3% subjects. The tortuosity was absent in 75.3%. The distance between CS ostium and the ostium of the vein ideal for lead implantation was between 10-40 mm in 76% subjects.Conclusions: The basic knowledge of coronary sinus and its tributaries play a significant role during electrophysiological procedures. The data obtained from the study can be utilised by interventional cardiologist for cannulation of coronary sinus in Kashmiri population.
ABSTRACT
BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive condition with right ventricular myocardium being replaced by fibro-fatty tissue. The spectrum of the expression may range from benign palpitations to the most malignant sudden death. Most of the mutations identified for the condition are localized in desmosomal proteins although three other nondesmosomal genes (cardiac ryanodine receptor-2, TGF-β3, and TMEM43) have also been implicated in ARVC. Both desmosomal and nondesmosomal genes were screened in a set of patients from local population. MATERIALS AND METHODS: A set of 34 patients from local population were included in this study. Diagnosis was based on the criteria proposed by task force of European Society of Cardiology/International Society and Federation of Cardiology. Polymerase chain reaction-based single-strand conformation polymorphism analysis was carried out, and samples with abnormal band pattern were commercially sequenced. RESULTS: Screening of cardiac ryanodine receptor revealed an insertion of a base in the intronic region of exon-28 in a patient, leading to a creation of a cryptic splice site. Screening of plakohilin-2 for mutations revealed an abnormal band pattern in three patients. Two of them had similar abnormal band pattern for exon-3.1. Sequencing revealed a novel 2 base pair deletion (433_434 delCT), which would lead to premature truncation of the protein (L145EfsX8). Another patient showed abnormal band pattern for exon-3.2 and sequencing revealed a missense mutation C792T leading to amino acid change P244L, in N-terminal, and this substitution may cause disturbances in the various protein–protein interactions. CONCLUSION: This study reports novel cardiac ryanodine receptor (RyR-2) mutations and Pkp-2 for the first time from Indian population.