Anatomical Study of the Cardiac Veins and their Tributaries in Bovines (Bos indicus) in Comparison with Humans and Other Animal Species / Estudio Anatómico de las Venas Cardiacas y sus Tributarias en Bovinos (Bos indicus) en Comparación con Humanos y Otras Especies Animales

SUMMARY: In bovines, anatomical observations of the coronary vascular tree describe qualitative characteristics. The objective of this study was to morphometrically characterize the coronary veins and their tributaries in cattle. An arcuate application with 2.0 silk was performed around the ostium of the coronary sinus of 28 bovine hearts and a number 14 catheter was placed, through which semi- synthetic polyester resin and mineral blue color was perfused. In 22 hearts (78.6 %) the great cardiac vein was originated at the cardiac apex. The configuration of the arteriovenous trigone was mainly closed inferior and superior types (50 %). The caliber of the great cardiac vein at the level of the atrioventricular sulcus was 6.7 +/- 1.2 mm. The origin of the left marginal vein was observed in the lower third of the left cardiac margin (53.6 %), its distal caliber was 4.1 +/- 0.8 mm and its drainage was at the level of the great cardiac vein. The middle cardiac vein originated from the cardiac apex in 78.6 % of the samples, emptied mainly into the coronary sinus (82.1 %) and its distal caliber was 4.7 +/- 0.9 mm. Anastomoses occurred in 28.6 % of the hearts, being found in most cases between the middle cardiac vein and the great cardiac vein (50 %), which was significant compared to other anastomoses (p<0.001). The length of the coronary sinus was 42.2 +/- 5.1 mm, its distal caliber was 13.8 +/- 2 mm, and its shape was cylindrical. Myocardial bridges were found in 3 hearts (10.7 %) mainly in the lower third of the middle cardiac vein (66.6 %). Most of the main coronary veins drained into the coronary sinus, with some cases with atypical outlets and the presence of a high percentage of anastomosis that serves to improve cardiac venous drainage in case of venous compression or obstruction.

En bovinos, las observaciones anatómicas de árbol vascular coronario describen características cualitativas. El objetivo de este estudio fue caracterizar morfométricamente las venas coronarias y sus tributarias en bovinos. Se realizó una aplicatura arciforme con seda 2.0 alrededor del ostium del seno coronario de 28 corazones de bovino y se colocó un catéter número 14, a través del cual se perfundió resina de poliéster semisintética y color azul mineral. La vena cardiaca magna se originó en 22 corazones (78,6 %) en el ápex cardiaco. La configuración del trígono arteriovenoso fue principalmente cerrado inferior y superior (50 %). El calibre de la vena cardiaca magna a nivel del surco atrioventricular fue 6,7 +/- 1,2 mm. El origen de la vena marginal izquierda se observó en el tercio inferior del margen izquierdo cardiaco (53,6 %), su calibre distal fue 4,1 +/- 0,8 mm y su desembocadura fue a nivel de la vena cardiaca magna. La vena cardiaca media se originó en el ápex cardiaco en el 78,6 % de las muestras, desembocó principalmente en el seno coronario (82.1 %) y su calibre distal fue 4,7 +/- 0,9 mm. Se presentó anastomosis en el 28,6 % de los corazones, encontrándose en la mayoría de los casos entre la vena cardiaca media y la vena cardiaca magna (50 %), lo cual fue significativo en comparación con otras anastomosis (p<0,001). La longitud del seno coronario fue 42,2 +/- 5,1 mm, su calibre distal fue 13,8 +/- 2 mm y su forma fue cilíndrica. Se encontró puentes miocárdicos en 3 corazones (10,7 %) y en el tercio inferior de la vena cardiaca media (66,6 %). La mayoría de las venas coronarias principales desembocan en el seno coronario, con algunos casos con desembocaduras atípicas y la presencia de un alto porcentaje de anastomosis que sirve para mejorar el drenaje venoso cardiaco en caso de compresión u obstrucción venosa.

Totally Endoscopic MICS via Left Atriotomy Using a Right-Side Approach for Patch Closure of an Unroofed Coronary Sinus Atrial Septal Defect / 日本心臓血管外科学会雑誌

A 51-year-old male was unexpectedly diagnosed with unroofed coronary sinus atrial septal defect (CSASD) by coronary computed tomography angiography for a complaint of epigastric pain. As there was no persistent left superior vena cava (LSVC), we planned to undertake a totally endoscopic MICS approach. A 4-cm skin incision was made on the right lateral chest wall under general anesthesia. The 4th intercostal space was used to enter the chest and the right femoral vessels were cannulated for cardiopulmonary bypass. After cross-clamping of the aorta, a right-sided atriotomy incision was made on the left atrium. The CSASD was located at the ventral and caudal regions of the mitral valve and the defect was closed using a bovine pericardial patch. No major postoperative complications were observed. The patient was discharged 7 days after the operation as postoperative transthoracic echocardiography revealed no residual shunt. We thus observed that totally endoscopic MICS patch closure via left atriotomy using a right-side approach for CSASD without LSVC was beneficial to the patient.

Ensayo clínico: efecto del sulfato de magnesio sobre los niveles séricos de lactato en el seno coronario / Clinical trial: effect of magnesium sulfate on serum levels of lactate in the coronary sinus

Resumen: Introducción: Se han propuesto varios métodos para controlar la inflamación y preservar el miocardio durante la circulación extracorpórea (CEC), entre ellos podemos mencionar la administración de electrolitos, tales como el magnesio (Mg2+). Objetivo: Comparar el efecto del uso de sulfato de magnesio (MgSO4) prepinzamiento aórtico (pre-PAo) vs placebo sobre los niveles séricos de lactato en el seno coronario en pacientes sometidos a revascularización miocárdica (RVM) multivaso con CEC. Material y métodos: Se realizó un ensayo clínico controlado en 52 pacientes sometidos a RVM multivaso con CEC, aleatorizados para recibir placebo (grupo I) o MgSO4 (grupo II) pre-PAo, y se tomaron muestras sanguíneas del seno coronario en dos tiempos diferentes: T0: pre-PAo y T1: previo al cierre de tórax, cuantificándose el lactato sérico. Para su análisis, se utilizó t de Student y χ2. Una p < 0.05 fue significativa. La información se procesó en SPSS v-22.0. Resultados: Los niveles séricos de lactato en el seno coronario postpinzamiento aórtico (pos-PAo) fueron menores en el grupo II (2.967 ± 0.86 vs 2.154 ± 1.14) mostrando diferencias significativas (p = 0.006). Conclusión: El uso de MgSO4 pre-PAo disminuye los niveles séricos de lactato en el seno coronario en pacientes sometidos a RVM multivaso con CEC.

Abstract: Introduction: Several methods have been proposed to control inflammation and to preserve the myocardium during cardiopulmonary bypass (CABG), including the administration of electrolytes such as magnesium (Mg2+). Objective: To compare the effect of using magnesium sulfate (MgSO4) or a placebo before aortic clamping (AoC) on the serum levels of lactate in the coronary sinus in patients undergoing myocardial multivessel revascularization (MRV) with CABG. Material and methods: A clinical assay was conducted with 52 patients undergoing MRV multivessel with CEC; the patients were randomized to receive a placebo (group I) or MgSO4 (group II) before AoC, and blood samples were taken from the coronary sinus to quantify serum lactate at two different times: T0: pre-AoC and T1: before closing the chest. Statistical analysis was performed on Student's t-test and χ2. A p < 0.05 was considered statistically significant. The data were processed with SPSS v-22.0. Results: Serum levels of lactate in the coronary sinus post-AoC were lower in group II (2.967 ± 0.86 vs 2.154 ± 1.14), with significant differences (p = 0.006). Conclusion: The use of MgSO4 before AoC reduces serum lactate levels in the coronary sinus in patients undergoing MRV multivessel with CABG.

Implante de un electrodo de estimulación ventricular izquierdo mediante doble canulación del seno coronario, técnica de snare y acceso retrógrado de la vena posterolateral / Implant of a left ventricular pacing electrode by double cannulation of the coronary sinus, snare technique and retrograde access of the posterolateral vein

Resumen El implante percutáneo de un electrodo de estimulación ventricular izquierdo a través del seno coronario para resincronización cardiaca siempre ha implicado un reto y más aún en pacientes con anatomía venosa coronaria compleja. Este caso demuestra cómo una técnica de doble canulación del seno coronario con uso de catéter multi-snare permite la colocación exitosa de un electrodo de estimulación ventricular izquierdo mediante acceso retrógrado a una vena posterolateral estenótica.

Abstract The percutaneous implantation of a left ventricular pacing electrode through the coronary sinus for cardiac resynchronization has always been a challenge, especially in patients with a complex coronary venous anatomy. This case shows how double cannulation of the coronary sinus using a multisnare catheter allows a left ventricular pacing electrode to be placed through retrograde access to a stenotic posterolateral vein, with a good clinical outcome.

Guía atrapada durante cambio de electrodo del seno coronario en terapia de resincronización cardiaca / Trapped guidewire during coronary sinus electrode exchange in cardiac resynchronization therapy

Resumen Se presenta el caso de una paciente con atrapamiento de guía al interior del seno coronario durante el procedimiento de cambio de un electrodo (Sentus ProMRI OTW BP L-85) por desalojo asociado a disfunción de la terapia de resincronización cardiaca. Durante el implante del nuevo electrodo se presentó atrapamiento y retención intravascular de la guía utilizada para su posicionamiento a nivel del seno coronario, lo cual hizo imposible su remoción. La paciente no aceptó tratamiento quirúrgico, se encuentra en vigilancia médica y permanece asintomática desde hace 3 años.

Abstract It is reported the case of a patient with guidewire trapping inside the coronary sinus during an electrode exchange procedure (Sentus ProMRI OTW BP L-85) due to dislocation associated with dysfunction of cardiac re-synchronization therapy. During the implantation of the new electrode, entrapment of the guidewire used for its positioning at the level of the coronary sinus and intravascular retention were presented, making it impossible to remove it. The patient did not accept surgical treatment and has been under medical surveillance, asymptomatic for three years.

3D Rapid Prototyping Heart Model Validation for Teaching and Training - A Pilot Project in a Teaching Institution

Abstract Introduction: Rapid prototyping is a process by which three-dimensional (3D) computerized surface models are converted into physical models. In this study, a 3D heart bio model was created using the rapid prototyping method and the accuracy of this heart model was assessed by clinicians. Methods: The two-dimensional images of normal heart from gated computed tomography scan datasets were used to create a 3D model of the heart. The slices were then processed using the software BioModroid and printed with the 3D printer. The evaluation of the model was performed by a questionnaire answered by four cardiothoracic surgeons, 12 cardiologists, five radiologists, and nine surgical registrars. Results: Eighty-six percent of the anatomy structures showed in this model scored 100% accuracy. Structures such as circumflex branch of left coronary artery, great cardiac vein, papillary muscle, and coronary sinus were each rated 77%, 70%, 70%, and 57% accurate. Among 30 clinicians, a total of 93% rated the model accuracy as good and above; 64% of the clinicians evaluated this model as an excellent teaching tool for anatomy class. As a visual aid for surgery or interventional procedures, the model was rated excellent (40%), good (50%), average (23%), and poor (3%); 70% of the clinicians scored the model as above average for training purpose. Overall, this 3D rapid prototyping cardiac model was rated as excellent (33%), good (50%), and average (17%). Conclusion: This 3D rapid prototyping heart model will be a valuable source of anatomical education and cardiac interventional management.

Malformación de Dandy-Walker asociada a malformaciones extracraneales en un neonato / Dandy-Walker malformation associated with extracranial abnormalities in a newborn

La hidrocefalia es una condición clínica que consiste en un cúmulo de líquido cefalorraquídeo a nivel encefálico. Una de las causas, poco frecuente, es el síndrome de Dandy-Walker. Se presenta el caso de un recién nacido con diagnóstico prenatal de hidrocefalia secundaria a una malformación de Dandy-Walker y sospecha de genitales ambiguos. Tras el nacimiento, se confirma el diagnóstico prenatal de malformación de Dandy-Walker asociado a manifestaciones extracraneales poco frecuentes como hipospadias interescrotal y dilatación del seno coronario secundario a persistencia de la vena cava superior izquierda. Con este caso clínico queremos exponer la complejidad del síndrome de Dandy-Walker debido a sus múltiples asociaciones, que marcarán el pronóstico del paciente y la necesidad de tratamiento multidisciplinar.

Hydrocephalus is a clinical condition that consists of an accumulation of cerebrospinal fluid around the brain; Dandy-Walker syndrome is a rare cause of it. We present the case of a newborn with prenatal diagnose of hydrocephalus due to a Dandy-Walker malformation, as well as ambiguous genitalia. After birth, diagnosis of Dandy-Walker malformation associated with uncommon extracranial manifestations is confirmed. Specifically, the baby presents interscrotal hypospadias and coronary sinus dilatation due to the persistence of the left superior vena cava. With the exposition of this case, we bring out the complexity of the Dandy-Walker syndrome due to the malformations associated with it; the ones that will determine the prognosis and the need of a multidisciplinary treatment

Anomalía de Ebstein y aneurisma del seno coronario / Ebstein’s anomaly and coronary sinus aneurysm

Resumen La anomalía de Ebstein es una cardiopatía congénita poco común que se asocia a la presencia de vías de conducción anómalas y episodios de taquicardia supraventricular frecuentes, algunos inestables. La asociación con alteraciones anatómicas del seno coronario es rara y no ha sido reportada. Se presenta el caso de una paciente de 58 años con enfermedad coronaria, anomalía de Ebstein, episodios de taquicardia ortodrómica y aneurisma del seno coronario, a quien se realizó ablación.

Abstract Ebstein’s disease is a congenital cardiomyopathy, with a low prevalence in the general population. This abnormality has been associated with abnormal cardiac conduction problems, one of the most important being the accessory pathways. In the presence of an accessory pathway, frequent supraventricular tachycardias may occur, some of which are poorly tolerated. The association with the anomalies of the coronary sinus is not currently reported. The case of a 58-year-old woman with Ebstein’s disease, episodes of supraventricular tachycardia, and coronary sinus aneurysm undergoing ablation therapy is presented.

Coexistent mitral stenosis and left circumflex coronary artery to left atrial fistula in a patient with severe pulmonary hypertension

Abstract Coronary artery to left atrial fistula is rare in patients with mitral stenosis. We report an interesting case of a patient with concomitant mitral valve stenosis and coronary fistulae, originating from the left circumflex artery and drained into the left atrium with two terminal orifices.

Ectopic connection of ductus venosus to dilated coronary sinus diagnosed by prenatal echocardiography: a case report / 中华围产医学杂志

We report a fetus with ectopic connection of venous catheter into the dilated coronary sinus, right-sided aortic arch, left-sided ductal arch, and aberrant left subclavian artery detected by routine prenatal ultrasound screening at 23 +2 gestational weeks. The baby was born vaginally at 38 +2 gestational weeks with an Apgar score of 10 at both 1 and 5 min. The reexamination of neonatal echocardiography on the second day after birth showed dilation of the internal diameter of the coronary sinus, right-sided aortic arch, and aberrant left subclavian artery. Follow-up at 90 days after birth found no abnormal growth and development.

A Case of Giant Unruptured Left Coronary Sinus of Valsalva Aneurysm / 日本心臓血管外科学会雑誌

We herein report a rare case of unruptured, giant left coronary sinus of Valsalva aneurysm and discuss surgical pitfalls associated with sinus of Valsalva aneurysms. A 63-year-old man was referred to us for clinical diagnosis and surgical treatment of a huge mass in the mediastinum. Enhanced computed tomography (CT) imaging revealed that the mass was a left coronary sinus of Valsalva aneurysm with a diameter of 74×57 mm ; moreover, the left coronary artery originated from the aneurysmal wall. In addition, echocardiography showed moderate aortic regurgitation (AR) caused by dilatation of the aortic annulus. Based on these findings, the Bentall procedure was selected for the Valsalva aneurysm and significant AR. The orifice of the aneurysm was 15×15 mm in size, and the aortic wall of the left coronary sinus was relatively thin. The left main trunk was injured due to severe adhesion between the trunk and the aneurysm ; therefore, vein patch repair was performed with a saphenous vein graft. Since the aortic annulus of the left coronary cusp was fragile, proximal anastomosis of the composite graft to the lesion had to be placed in the fibrous continuity between the aortic and mitral valves. With respect to the proximal anastomosis at the aortic annulus of the left coronary cusp, the suture line was covered with a bovine pericardium patch as there were no remnants of the normal aortic wall. The postoperative course was uneventful, and postoperative CT revealed complete resection of the aneurysm with no evidence of stenosis of the left main trunk.

Case report: surgical treatment of high-flow coronary fistulas for the pulmonary artery

Abstract Coronary fistulas are rare anomalies that can affect approximately 1% of the population, presenting few specific symptoms, and are often found occasionally in coronary angiography. Here we describe the case of a 61-year-old patient with complaints of precordialgia and dyspnea since adolescence, with late diagnosis of coronary fistulas with drainage to the pulmonary artery, and with unsuccessful percutaneous treatment. Therefore, she underwent open surgery for the correction of the already known fistulas, in addition to the hemangioma involving such vessels, which made the understanding and resolution of this case more complex.

Cierre de la comunicación interauricular por cateterismo intervencionista con dispositivo Amplatzer en pediatría / Atrial Septal defect closure by interventional catheterization with Amplatzer device in Pediatrics

Introducción: El cateterismo intervencionista corrige las cardiopatías complejas, donde el dispositivo Amplatzer es el más usado y está disponible en Cuba. Objetivo: Evaluar el cateterismo intervencionista con Amplatzer, en el cierre de la comunicación interauricular ostium secundum. Métodos: Estudio de evaluación, longitudinal y prospectivo en 92 pacientes. El cierre de la comunicación por cateterismo con Amplatzer, se realizó en el Cardiocentro Pediátrico William Soler (2010-2016). Se utilizaron variables demográficas, ecocardiográficas (transtorácicas y transesofágicas) antes, durante y al año del cateterismo. Se observaron las complicaciones. La evaluación clínica y ecocardiográfica se realizó al año poscateterismo. Los pacientes a quienes se les realizó el proceder en el 2016, se evaluaron a los 6 meses. Resultados: Se encontraron diferencias significativas en el sexo (p<0,05): femenino 64,1 por ciento con homogeneidad para la edad (p= 0,244): media 9,8 años ( 5 desviaciones estándar. Precateterismo: 28,3 por ciento eran desnutridos y 17,4 por ciento delgados; poscateterismo la desnutrición mejoró significativamente (p= 0,000): desnutridos 9,8 por ciento y delgados 8,7 por ciento. El diámetro medio del defecto por ecocardiografía transcateterismo fue significativo (p= 0,000). Transcateterismo: 98,9 por ciento con cierre de defecto, 16,3 por ciento con insuficiencia tricúspidea y 4,3 por ciento con insuficiencia mitral. Poscateterismo: 98,9 por ciento con Amplatzer bien colocado. Hubo complicaciones inmediatas en 8,7 por ciento (arritmias, derrame pericárdico y embolización). Al año se detectó cortocircuito residual pequeño (n= 1) e insuficiencias valvulares auriculoventriculares (n= 3). La evolución fue satisfactoria (n= 91). Conclusiones: La evolución del cierre de la comunicación interauricular ostium secundum con dispositivo Amplatzer es satisfactoria, con mejoras de la desnutrición(AU)

Introduction: The interventional catheterization corrects complex heart diseases, and the Amplatzer device is the most widely used and is available in Cuba. Objective: To assess the interventional catheterization with Amplatzer device in the ostium secundum atrial septal closure. Methods: Longitudinal and prospective evaluation study in 92 patients. The closure of the communication by Amplatzer catheterization was performed in the William Soler Pediatric Cardiocenter of (2010-2016). Demographic and echocardiographic (transthoracic and transesophageal) variables were used before, during, and at the year of the catheterization. Complications were observed. Clinical and echocardiographic assessment was made a year after catheterism. The patients who underwent the procedure in 2016 were evaluated at 6 months. Results: Significant differences were found in the sex (p< 0.05): Female 64.1 t percent with homogeneity of the age (p= 0.244): average 9.8 years ( 5 standard deviations. Pre-catheterism: 28.3 percent were malnourished and 17.4 percent thin; post-catheterism: malnutrition improved significantly (p= 0.000): 9.8 percent malnourished and 8.7 percent thin. The average diameter of the defect by transcatheter echocardiography was significant (p= 0.000). Transcatheter: 98.9 percent : with default closure, 16.3 percent with tricuspid insufficiency and 4.3 percent with mitral regurgitation. Post-catheterism: 98.9 percent with Amplatzer device correctly positioned. There were immediate complications in 8.7 percent (arrhythmia, pericardial effusion, and embolization). A year after, small residual short circuit was detected (n= 1), and atrioventricular valve regurgitation (n= 3). The evolution was satisfactory (n= 91). Conclusions: The evolution of ostium secundum atrial septal defect´s closure with Amplatzer device is satisfactory and improves malnutrition(AU)

Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve in Patients with Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus

Unroofed coronary sinus syndrome: A case report / 中南大学学报(医学版)

Unroofed coronary sinus syndrome (UCSS), also named coronary sinus septal defect, is a rare type of atrial septal defect with the incidence less than 1% of the total number of atrial septal defects. It is caused by incomplete formation of left atrial venous folds during embryonic development. Here we reported a patient with UCSS, who was treated in the Second Xiangya Hospital of Central South University. The patient was 50 years old and the main clinical manifestations were fatigue and shortness of breath after repeated exercise. Color Doppler echocardiography showed coronary sinus dilatation (17 mm×14 mm), indicating the possibility of permanent left superior vena cava. Pulmonary angiography showed that the left ventricle and coronary sinus were developed at the same time while the atrial septum was intact after the development of the left atrium, followed by the right atrium and right ventricle, indicating a partial anomalous pulmonary venous drainage (intracardiac type). Finally, the cardiac computed tomograhic angiography showed that 4 pulmonary veins and permanent left superior vena cava (PLSVC) went into the left atrium and the coronary sinus, respectively, while the coronary sinus septum was absent and the PLSVC was connected with the left atrium. The patient was later treated with the correction of non-parietal sinus syndrome in the Cardiovascular Surgery Department of our hospital.

Angiographic anatomy of the coronary sinus venous system in adult Kashmiri population

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.

‘Coronary Sinus Filling Time’- For Diagnosis of Microvascular Disease in Patients with Chronic Stable Angina

Patients having angina with normal epicardial coronary arteries are often considered to have coronary microvascular dysfunction that may result in coronary slow flow. Delayed Coronary Sinus Filling Time (CSFT) may represent transit time through coronary microcirculation.We evaluated CSFT in patients having angina with normal epicardial coronary arteries and compared it with control population. Methods: 31 patients having definite angina or probable angina with positive exercise tolerance test with normal epicardial coronary arteries in coronary angiogram (CAG) were included in the study group. 31 patients having normal epicardial coronary arteries in CAG during preoperative evaluation before surgical treatment for valvular and congenital heart diseases were in control group. CSFT, TIMI (Thrombolysis In Myocardial Infarction) frame count, cTIMI (Corrected TIMI) frame count and TMP (TIMI Myocardial Perfusion) score were assessed in CAG of both group and compared between groups. Results: Patients’ Mean±SD of age in study and control group were 48.84±9.50years and 46.71±5.53years respectively with no significant difference (p=0.569) and there was female preponderance (55% and 65%) in both groups. CSFT was significantly prolonged in study group (4.22±0.71sec vs. 3.65±0.25sec, P value 0.001) but TIMI frame count, cTIMI and TMP showed no significant difference between two groups (25.71±5.74 vs. 26.74±3.81, p= 0.552; 14.76±3.6 vs. 15.4±2.56, p=0.449; 2.54±0.5 vs. 2.61±0.49, p=0.326; respectively). Conclusion: We concluded that CSFT was significantly prolonged in patients having angina with normal epicardial coronary arteries which might be a marker for diagnosis of coronary microvascular disease.

A Case of Coronary Sinus Type Atrial Septal Defect Treated by 3-Port Totally Endoscopic Surgery / 日本心臓血管外科学会雑誌

A 15-year-old boy with coronary sinus type atrial septal defect (CS-ASD) was surgically treated with 3-port totally endoscopic technique. The patient was set in a left semi-lateral position. A 3 cm skin incision retracted by a small wound protector, a trocar for the endoscope, and a trocar for left-handed instruments were placed in the right antero-lateral chest. Cardio-pulmonary bypass was established via groin cannulation. After cardioplegic arrest, the CS-ASD was favorably exposed through the left atriotomy, and closed using a bovine pericardial patch. The total operation time was 112 min. The post-operative course was uneventful. Instead of the traditional median sternotomy and right atriotomy, small right thoracotomy and left atriotomy may be a promising alternative for closure of CS-ASD.

The quantification of Z-score of the color flow widths of atrioventricular valves in the fetuses with dilation of the coronary sinus / 中华超声影像学杂志

Objective To calculate Z-score for mitral and tricuspid color blood flow widths in normal fetuses and fetuses with dilated coronary sinuses ( CS ) using fetal echocardiography ,and explore the application value of Z-score of the color flow widths of atrioventricular valves in normal fetuses and fetuses with dilated CS . Methods Two hundred and thirty-eight normal fetuses (control group) with a gestational age of 16 to 38 weeks were studied by color Doppler echocardiography . Gestational age ( GA ) ,biparietal diameter (BPD) ,femoral length (FL) ,aortic inner diameter (AOd) ,pulmonary artery diameter (PAd) ,and heart area ( HA) were measured as independent variables ,and mitral and tricuspid valve color flow widths were measured as the dependent variables . Z-score models were established by regression analysis . Thirty fetuses with dilated CS (dilated CS group) from 22 to 33 weeks'gestation were involved . The Z-score of the CS fetus was calculated based on the established Z-score models and were compared with those of the normal fetuses . Results The independent sample t-test showed that there were no significant differences in the Z-scores of the blood flow width of the fetal mitral and tricuspid valves between dilated CS group and control group ( P >0 .05) . Conclusions The simple dilated CS does not affect the mitral valve diastolic blood flow ,so there is no significant effect on the filling of left ventricular blood flow .