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.

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.

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.

An innovative method in venous coronary cast technique / 대한해부학회지

Polyurethane foam (PU foam) is a new material which is being used in producing both macro-anatomical and micro-anatomical specimens. PU foam is simple to use, without need for special equipment. The present study was carried out to evaluate morphology of coronary sinus and its tributaries. During the study, we encountered few problems in carrying out injections. Coronary sinus and its tributaries were difficult to cannulate since the coronary sinus lacks a vascular stem, around which ligature can be tied before injection so that the cannula can be held in place. In contrast, in majority of the organs it is easy to inject since they possess tubular vascular stem to hold the cannula in place. A new device was developed which could be used to cannulate coronary sinus orifice to inject the casting media. The second problem we faced was saponification of adipose tissue. This made corrosion of the soft tissue difficult. Hence in this study, we describe the device we have developed to place in the coronary sinus orifice, and how saponified adipose tissue was taken care during the actual maceration step.

Echocardiographic Study of the Coronary Sinus in the Indeterminate Form of Chagas Disease

Abstract INTRODUCTION: We investigated the occurrence of coronary sinus abnormalities in the indeterminate form of Chagas disease (CD). METHODS: Differences between the maximum and minimum diameters of the coronary sinus (∆%) on echocardiography were evaluated in individuals with the indeterminate form of CD (n=14) and those without (n=16) CD. The association of the difference with abnormalities detected by echocardiography and myocardial scintigraphy was assessed. RESULTS: The mean Δ% values did not differ significantly between the groups. There was no correlation of the measurements with echocardiographic and myocardial scintigraphy findings. CONCLUSIONS: The coronary sinus evaluation revealed no differences between the groups.

Cardiac resynchronization therapy: overcoming anatomical challenges / Terapia de ressincronização cardíaca: superando desafios anatômicos

A anatomia venosa coronária pode dificultar ou impossibilitar o implante com sucesso de um dispositivo de terapia de ressincronização cardíaca. O objetivo desta revisão foi o de apresentar uma abordagem interventiva com muitas técnicas e ferramentas que precisam ser aprendidas e conhecidas para melhorar os resultados desta terapia e a saúde dos pacientes

Coronary venous anatomy can make successful implantation of a cardiac resynchronization therapy device difficult or impossible. The aim of this review is introduce an interventional approach with many techniques and tools that are needed to be learned and known in order to improve the results of this therapy and the health of patients

Unroofed Coronary Sinus Atrial Septal Defect Misdiagnosed as Ostium Primum Defect

No abstract available.

Management of Coronary Sinus Ostial Atresia during a Staged Operation of a Functional Single Ventricle

Coronary sinus ostial atresia (CSOA) with persistent left superior vena cava (LSVC) in the absence of an unroofed coronary sinus is a benign and rare anomaly that may be taken lightly in most instances. However, if overlooked in patients undergoing univentricular heart repair such as bidirectional Glenn or Fontan-type surgery, fatal surgical outcomes may occur due to coronary venous drainage failure. We report a case of CSOA with a persistent LSVC that was managed through coronary sinus rerouting during a total cavopulmonary connection, and provide a review of the literature regarding this rare anomaly.

Taxa de sucesso de posicionamento de cabo-eletrodo ventricular esquerdo em região-alvo sem utilização de bainha e/ou venografia durante procedimento de implante de marcapasso biventricular / Success rate of left ventricular lead positioning in target region without a sheath and/or venography during biventricular pacemaker implantation procedure

Introdução: Este trabalho teve por objetivo avaliar a taxa de sucesso de implante de cabo-eletrodo ventricular em região lateral sem uso de venografia. Método: Foram analisados 100 casos de implante de cabo-eletrodo ventricular esquerdo ao longo de 30 meses, em um único centro, quanto a sua localização e calculada a taxa de implantes em parede lateral (ântero-lateral, lateral e póstero-lateral). Todos os procedimentos foram realizados sem uso de bainha e sem realização de venografia, por meio de técnica de cateterização do seio coronário baseada no componente atrial do eletrograma endocavitário. Resultados: Em 83% dos casos foi conseguido implante em parede lateral, predominantemente em paredes póstero-lateral e lateral, com tempo de radioscopia médio de 5,97 minutos. Em 10% houve insucesso, com necessidade de implante de cabo-eletrodo epicárdico. Conclusão: O implante de cabo-eletrodo ventricular esquerdo em região lateral sem uso de venografia baseado no componente atrial do eletrograma endocavitário constitui técnica segura e eficaz, apresentando ainda redução do tempo de radioscopia

Background: This study was aimed at evaluating left ventricular pacing implant success rate in the lateral region without the use of venography. Method: We analyzed 100 cases of left ventricular lead implants over 30 months in a single center as to the location of the left ventricular lead and calculated the rate of implants in the lateral wall (anterolateral, lateral and posterolateral). All procedures were carried out without the use of a sheath and without performing venography using the coronary sinus catheter technique based on the atrial endocardial electrogram component. Results: In 83% of cases it was successfully implanted in the lateral wall, predominantly in the posterolateral and lateral walls, with a mean radioscopy time of 5.97 minutes. It failed in 10% of the cases and we had to use an epicardial lead. Conclusion: Left ventricular lead implantation in the lateral region without venography based on atrial component of the endocavitary electrogram is a safe and effective technique, which also reduces radioscopy time

Persistencia de la vena cava superior izquierda: Presentación de un caso / Persistent Left Superior Vena Cava: Case Report

La vena cava superior izquierda persistente es una variante anatómica poco común, pero su conocimiento por parte de los médicos es importante para algunos procedimientos, como inserción de catéteres, entre otros. Se ha descrito desde 1950 y se asocia con anomalías cardiacas. Esta estructura venosa tiene varios sitios donde drenar los cuales se deben conocer. Casi siempre es un hallazgo incidental, pero se ha asociado a accidente cerebrovascular y muerte. Para su diagnóstico se han utilizado varias modalidades de imagen, como ecocardiografía, tomografía computarizada (TC) y resonancia magnética (RM).

Persistent left superior vena cava is a rare anatomical variant, which should be known by physicians, since it is relevant for some procedures such as insertion of catheters and pacemakers. Described in the literature since 1950, it has been associated with several cardiac anomalies. This venous structure drains towards several places, which must be known. Although most of the time it is an incidental finding, it has been associated with stroke and death. Imaging modalities such as CT, MRI and echocardiography are helpful for its diagnosis.

Anomalías congénitas y variantes anatómicas del seno coronario / Congenital Anomalies and Anatomical Variants of Coronary Sinus

El seno coronario (SC) es la estructura vascular que permite el acceso a las venas coronarias en procedimientos intervencionistas como el mapeo y la ablación de arritmias, la implantación de electrodos izquierdos en terapia de resincronización, anuloplastia mitral, tratamiento con células madre y cardioplejía retrógrada. El éxito de estos procedimientos depende del conocimiento de la anatomía del SC, del reconocimiento de sus variantes y anomalías. La tomografía multicorte permite obtener imágenes de la anatomía del SC sin necesidad de procedimientos invasivos de diagnóstico. La resonancia magnética, por su condición no invasiva y sin radiación, también es útil en la evaluación del seno coronario porque permite la valoración morfológica y funcional de diversas anomalías congénitas del corazón.

The coronary sinus (CS) is an important vascular structure that allows access to the coronary veins in multiple interventional procedures such as mapping and ablation of arrhythmias, implantation of left ventricular electrodes in resynchronization therapy, mitral annuloplasty, stem cells therapy, and retrograde cardioplegia. The success of these procedures is facilitated by the knowledge of the CS anatomy, in particular the recognition of its variants and anomalies. The widespread availability of multislice CT (MSCT) allows non-invasive image acquisition with excellent representation of the CS anatomy, avoiding thus the need for invasive diagnostic procedures. MRI is also useful for the non-invasive evaluation of the coronary sinus, without radiation, allowing the morphological and functional assessment of various congenital heart abnormalities.

A New Root-Strengthening Technique for Acute Aortic Dissection with a Weakened Aortic Root: The Neo-Adventitia Technique

BACKGROUND: Dissection flaps in acute type A aortic dissection typically extend into the root, most frequently into the non-coronary sinus (NCS). The weakened root can be susceptible not only to surgical trauma, but also to future dilatation because of its thinner layers. Herein, we describe a new technique that we named the “neo-adventitia” technique to strengthen the weakened aortic root. METHODS: From 2012 to 2016, 27 patients with acute type A aortic dissection underwent supracommissural graft replacement using our neo-adventitia technique. After we applied biologic glue between the dissected layers, we wrapped the entire NCS and the partial left and right coronary sinuses on the outside using a rectangular Dacron tube graft that served as neo-adventitia to reinforce the dissected weakened wall. Then, fixation with subannular stitches stabilized the annulus of the NCS. RESULTS: There were 4 cases of operative mortality, but all survivors were discharged with aortic regurgitation (AR) classified as mild or less. Follow-up echocardiograms were performed in 10 patients. Of these, 9 showed mild or less AR, and 1 had moderate AR without root dilatation. There were no significant differences in the size of the aortic annulus (p=0.57) or root (p=0.10) between before discharge and the last follow-up echocardiograms, and no reoperations on the aortic roots were required during the follow-up period. CONCLUSION: This technique is easy and efficient for reinforcing and stabilizing weakened roots. Furthermore, this technique may be an alternative for restoring and maintaining the geometry of the aortic root. An externally reinforced NCS could be expected to resist future dilatation.

Unroofed Coronary Sinus: Multimodality Imaging of Geriatric Congenital Heart Disease

No abstract available.