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.

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.

Relationship Of Great Cardiac Vein In The Triangle Of Brocq And Mouchet- A Corrosion Cast Study

Background: The triangle of Brocq and Mouchet is an arteriovenous triangle between the anterior interventricularartery, circumflex artery and the great cardiac vein. The vascular triangle has been classified into 4 types viz.closed, superiorly opened, inferiorly opened and completely opened or absent. Polyurethane foam is a newmaterial used in corrosion casting. It is economical, easy to carry out and does not require special apparatus.Context and purpose of the study:a) To study the relationship of the Great cardiac vein (GCV) in the triangle of Brocq and Mouchet in human heartsusing PU foam for corrosion cast.b) To study the relationship of GCV in relation to the arteries forming the triangle.Results: The triangle was present in 98% of the hearts. Relationship of GCV in triangle of Brocq and Mouchet:Inferiorly open type of Triangle was the most common (87.5%). Next common type was, closed type (6.7%). Inrelation to GCV relation with the arteries in the triangle, it was to the left of AIA in 87.51% and crosses circumflexartery, either superficially or deep.The GCV crossing anterior interventricular artery was found in few specimens. It crossed the artery superficiallyor deeply. The intertwining type of variation was observed in few casts, and could not be placed under anyclassification as suggested by previous authors.Conclusion: The topography of the Great cardiac vein and its variations are significant in relation to the arteriesin the region. It is relevant in interventional cardiology, radiology, and catheter-based procedures.

Transvenous Implantation of an Implantable Cardioverter Defibrillator in a Patient Who Had Undergone Tricuspid Valve Replacement / 대한내과학회지

Transvenous implantation of an implantable cardioverter defibrillator in patients with a prosthetic valve in the tricuspid position is difficult because a defibrillator lead cannot be implanted into the right ventricle through the prosthetic valve. Hence, there are three options: epicardial implantation, subcutaneous implantable cardioverter defibrillator implantation, and cardiac vein implantation. Here, we report the transvenous implantation of an implantable dual-chamber cardioverter defibrillator in a patient who had undergone tricuspid valve replacement with a prosthetic valve. The patient was a 70-year-old female with a prosthetic valve in the tricuspid position who had experienced two events of sudden cardiac arrest. We successfully performed the procedure by implanting the defibrillator lead into the middle cardiac vein.

Anatomical considerations of percutaneous transvenous mitral annuloplasty: a novel procedure for treatment of functional mitral regurgitation / 대한해부학회지

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.

Clinical research on radiofrequency catheter ablation for treating epicardial accessory pathway / 重庆医学

Objective To investigate the efficacy and safety of radiofrequency catheter ablation for treating epicardial accessory pathway .Methods 8 patients with unsuccessful endocardial ablation of accessory pathway were mapped within coronary venous si-nus or middle cardiac vein and the radiofrequency catheter ablation was performed by the temperature control electrode .Results Ablation in 8 cases was successfully performed within coronary sinus or middle cardiac vein .There were no complications in all pa-tients .Conclusion Radiofrequency catheter ablation of epicardial accessory pathway within coronary sinus and middle cardiac vein is safe and effective .

Long-term Prognosis of Left Ventricular Lead

Transvenous left ventricular (LV) lead implantation is on the increase due to cardiac resynchronization therapy (CRT). However, there has been paucity of data on the prognosis of LV lead. Consecutive 32 patients with LV lead for CRT (n=22) or pacemaker (n=10) were subjected. Serial changes in pacing threshold and impedance along with lead-related complications were evaluated. Over 2 yr follow-up, there was no significant change in relative threshold voltage to the initial value (100%, 110%, 89.6%, and 79.6% at baseline, 1, 6, and 24 months respectively, P=0.62) as well as lead impedance (816+/-272, 650+/-178, 647+/-191, and 590+/-185 ohm at baseline, 1, 6, and 24 months respectively, P=0.80). The threshold change was not affected by lead position, lead polarity, and indication of lead implantation. The cumulative rates of lead revision were 6.3% (n=2) and 9.4% (n=3) in 6 month and 2 yr follow-up, respectively. One case of phrenic nerve capture at left lateral decubitus position was detected 1 month after the implantation. However, there were no serious complications over 2 yr period. In conclusion, transvenous LV lead implantation showed favorable long-term prognosis. Pacing parameters remained stable without significant changes over 2 yr follow-up.

Initial results with left ventricular pacemaker lead implantation using a 2187 left ventricular pacing lead / 中国介入心脏病学杂志

Objective The aim was to investigate the manupulation and the localization of LV Lead, and to evaluate LV Lead usefulness in biventricular pacing.Methods 9 Patients with enlarged left ventricle, chronic heart failure, CLBBB and refractory to chemical therapy were selected in this study, including 8 males and 1 female. Coronary sinus venography was performed by injecting contrast medium retrogradely at coronary sinus ostium in 7 cases or antegradely into left coronary artery in 2 cases. LV lead was introduced to CS and localized at targeting vein of LV through a "peel away" guiding sheath, which was placed in CS via left subclavian vein route. Results Coronary sinus and its tributaris were clearly visualized by both antegrate cardiac venography and retrograte cardiac venography. 2187 leads were implanted into targeting veins through "peel away" guiding sheaths in 6 cases and directly introduced in 2 cases, while in other case the lead was inserted into coronary sinus directly after a failed procedure via a "peel away" guiding sheath. The leads were placed in great cardiac vein in 1 case, lateral LV vein in 2 cases, left posterior LV vein in 2 case and left posterolateral veins in 4 cases. The acute pacing and sensing thresholds measuered during the implanting procedure were in normal limits. 2187 leads were still fully functional without dislocalization during follow up of average 253 days. Conclusion CS and its tributaries can be clearly shown by antegrate and retrograte venographies. The introduction of 2187 left ventricular pacing is easily performed directly or through a preformed "peel away" guiding sheath. LV epicardium pacing by 2187 LV lead implanted through CS is feasible and reliable.