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Rev. colomb. cardiol ; 28(2): 180-184, mar.-abr. 2021. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1341281


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.

Humans , Female , Middle Aged , Ebstein Anomaly , Coronary Sinus , Accessory Atrioventricular Bundle , Aneurysm
Article in English | WPRIM | ID: wpr-812982


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.

Coronary Sinus , Heart Atria , Heart Septal Defects, Atrial , Humans , Middle Aged , Vena Cava, Superior
Anatomy & Cell Biology ; : 191-195, 2019.
Article in English | WPRIM | ID: wpr-762213


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.

Adipose Tissue , Catheters , Coronary Sinus , Coronary Vessels , Corrosion , Ligation , Methods , Polyurethanes
Rev. Soc. Bras. Med. Trop ; 51(6): 827-830, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-1041498


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.

Humans , Male , Female , Adult , Chagas Cardiomyopathy/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Coronary Sinus/diagnostic imaging , Echocardiography , Chagas Cardiomyopathy/physiopathology , Ventricular Dysfunction, Left/physiopathology , Coronary Sinus/physiopathology , Coronary Sinus/parasitology
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 31(4): 146-155, out.-dez. 2018. tab, ilus
Article in English | LILACS | ID: biblio-999176


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

Humans , Male , Female , Coronary Sinus , Cardiac Resynchronization Therapy/methods , Phrenic Nerve , Cardiac Pacing, Artificial , Ventricular Function, Left , Coronary Vessels , Electrodes, Implanted , Catheters
Article in English | WPRIM | ID: wpr-714025


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.

Coronary Sinus , Drainage , Fontan Procedure , Heart , Heart Bypass, Right , Humans , Vena Cava, Superior
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 30(2): f:43-l:46, abr.-jun. 2017. ilus, graf
Article in Portuguese | LILACS | ID: biblio-848020


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

Humans , Electrodes , Heart Ventricles , Pacemaker, Artificial , Phlebography/methods , Prostheses and Implants , Cardiac Resynchronization Therapy/methods , Catheterization/methods , Cohort Studies , Coronary Sinus , Defibrillators, Implantable , Electrocardiography/methods , Heart Failure/diagnosis , Treatment Outcome
Article in English | WPRIM | ID: wpr-175188


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.

Adhesives , Aorta , Aortic Valve Insufficiency , Cardiac Surgical Procedures , Coronary Sinus , Dilatation , Follow-Up Studies , Humans , Mortality , Polyethylene Terephthalates , Sinus of Valsalva , Survivors , Transplants
Rev. colomb. radiol ; 28(3): 4486-4488, 2017. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-986662


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.

Humans , Vena Cava, Superior , Venae Cavae , Coronary Sinus
Rev. colomb. radiol ; 28(1): 4643-4648, 2017. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-987017


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.

Humans , Coronary Sinus , Coronary Artery Disease , Multidetector Computed Tomography
Article in English | WPRIM | ID: wpr-80169


In this report, we present a case of 35-year-old lady who had presented with atypical chest pain and exertional breathlessness for past six months. Transthoracic and transesophageal echocardiograms showed a well-circumscribed, echo-dense mass in the right atrium, attached to the interatrial septum at the level of atrioventricular junction and in the vicinity of coronary sinus ostium. She underwent successful resection of the cardiac mass. Histopathology revealed paraganglioma, which was reconfirmed by immunohistochemistry study. This represents an extremely rare presentation as primary cardiac tumors are 20-times less common than metastatic tumors and paraganglioma is one of the rarest primary cardiac tumors, accounting for < 1% of all cases.

Adult , Chest Pain , Coronary Sinus , Dyspnea , Heart Atria , Heart Neoplasms , Humans , Immunohistochemistry , Myxoma , Paraganglioma , Pheochromocytoma
Anatomy & Cell Biology ; : 68-72, 2016.
Article in English | WPRIM | ID: wpr-127238


Percutaneous transvenous mitral annuloplasty (PTMA) has evolved as a latest procedure for the treatment of functional mitral regurgitation. It reduces mitral valve annulus (MVA) size and increases valve leaflet coaptation via compression of coronary sinus (CS). Anatomical considerations for this procedure were elucidated in the present study. In 40 formalin fixed adult cadaveric human hearts, relation of the venous channel formed by CS and great cardiac vein (GCV) to MVA and the adjacent arteries was described, at 6 points by making longitudinal sections perpendicular to the plane of MVA, numbered 1–6 starting from CS ostium. CS/GCV formed a semicircular venous channel on the atrial side of MVA. Based on the distance of CS/GCV from MVA, two patterns were identified. In 37 hearts, the venous channel at point 2 was widely separated from the MVA compared to the two ends and in three hearts a nonconsistent pattern was observed. GCV crossed circumflex artery superficially. GCV or CS crossed the left marginal artery and ventricular branches of circumflex artery superficially in 17 and 23 hearts, respectively. As the venous channel was related more to the left atrial wall, PTMA devices probably exert an indirect traction on MVA. The arteries crossing deep to the venous channel may be compressed by PTMA device leading to myocardial ischemia. Knowledge of the spatial relations of MVA and a preoperative and postoperative angiogram may help to reduce such complications during PTMA.

Adult , Arteries , Cadaver , Coronary Sinus , Formaldehyde , Heart , Humans , Mitral Valve , Mitral Valve Annuloplasty , Mitral Valve Insufficiency , Myocardial Ischemia , Traction , Veins
Article in English | WPRIM | ID: wpr-70896


BACKGROUND AND OBJECTIVES: Intracardiac electrocardiograms (ECGs) from the coronary sinus (CS) provide important information for identifying a left-sided bypass tract. However, a previous study revealed an anatomical discrepancy between the CS and mitral annulus (MA) in cadaver hearts. The purpose of this study was to evaluate the anatomical relationship between the CS and MA in the living body by using fluoroscopy. SUBJECTS AND METHODS: We analyzed patients who had an ablation for 42 left-sided bypass tracts and one paroxysmal atrial fibrillation. A left atriogram was performed during the ablation by using a pigtail catheter via the transseptal approach. The distances between the CS and MA were measured at 30° right anterior oblique (RAO) and 60° left anterior oblique (LAO) projections at the end of ventricular systole and diastole. RESULTS: The distances between the CS and MA at the RAO projection were 9.74±3.50, 3.86±2.58, and 9.02±6.04 mm during systole and 12.89±5.59, 3.97±3.24, and 10.71±4.12 mm during diastole at the proximal, middle, and distal CS, respectively. The distances between the CS and MA at the LAO projection were 6.84±2.77, 1.80±1.51, and 4.57±3.24 mm during systole and 9.91±3.25, 4.21±3.59, and 7.02±3.12 mm during diastole at the proximal, middle, and distal CS, respectively. CONCLUSION: An anatomical discrepancy was detected between the CS and MA in most cases. Therefore, intracardiac ECGs of the CS cannot exactly localize left-sided bypass tracts.

Atrial Fibrillation , Cadaver , Catheters , Coronary Sinus , Diastole , Electrocardiography , Fluoroscopy , Heart , Humans , Systole