The behavior of three types of large sinus node arteries with regard to the blood supply of the atrial myocardium.

PURPOSE: We describe angiographic findings of sinus node arteries (SNAs), focusing in the large sinus node artery (LSNA) variants, regarding the blood supply of the SN and atrial myocardium. METHODS: We examined the SN arteries via postmortem angiographic visualization in six hundred hearts derived from victims of various accidents. RESULTS: The main stem or a branch of the SNA supplied the right atrium (RA) and part of the interatrial septum (IS) in 32% of cases (Group A), one atrium, the IS and a small part of the other atrium (Group B) in 39% and the entire atrial myocardium (LSNAs) (Group C) in 29%. Forty-two percent (42%) of LSNAs were arising from the anterior part of the right coronary artery (RCA) (type 1), 9% from its intermediate part (type 2) and 49% from the posterolateral portion of the left circumflex artery (LCx) (type 3). Type 2 can be injured by surgical procedures, type 3 by interventional ones, while type 1 is not affected by any. The SN area was supplied in Groups A and B by the main stem of SN arteries in 370 cases (62%) and by branches (Br) in 55 (9%). The 175 cases of group C (29%) were supplied only by branches. The clockwise (40% of cases) and counterclockwise rotations (60%) of the SNA around the superior vena cava, concern surgical procedures. CONCLUSION: The above findings are essential for every day surgical and interventional procedures.

Merkel cell carcinoma with kidney metastasis in a 81-year-old man. A rare case report.

Merkel cell carcinoma (MCC) is a primary neuroendocrine carcinoma of the skin. The prognosis of the disease is considered poor. Secondary metastasis is common, however a secondary metastasis to kidney from Merkel cell is a very rare phenomenon. We report a case of a man with a MCC metastasis to the right kidney. The suggested management is surgery and afterwards a platinum-based chemotherapy.

Age-related fibromuscular dysplasia in the human left ventricle papillary muscles arteries.

We describe histologically cases of patients between 31 and 60 years of age who had fibromuscular dysplasia (FMD) in the tunica media (TM) of the left ventricle papillary muscles (PM) arteries. We also compared them with our previous findings in subjects younger than 30 years of age. We examined histologically samples taken from the tip of the anterior PM of the left ventricle in 200 healthy male hearts. In 33 cases (16.5 %), FMD was in the TM. We divided these cases into three subgroups (A, B, C) based on the degree of replacement of smooth muscle cells by fibrous tissue, and thus identified 17, 11 and 5 cases, respectively. Until the age of 41, the typical lesions were often localized within the TM. Beyond that age, the fibrous tissue increased in the TM wall and in the surrounding area of the vessels, causing dysfunction of the PM. Degenerative lesions, as well as inflammatory infiltration, were found after the age of 53. The findings of this study will be useful to cardiologists and cardiac surgeons, in pointing out that, after the age of 44 years old, some PM and their supporting valves may present a degree of dysfunction.

Histological findings of the atrioventricular conductive system in street heroin addicts, victims of sudden unexpected death.

A study of the atrioventricular (AV) conducting tissue was considered necessary for the examination of probable histologic changes that could justify the arrhythmias observed in street-heroin addicts. Postmortem coronary angiography and microscopic examination were performed in 50 heroin addicts (group A) and in 50 nonaddicts (group B), all male 16-40 years old. In group A, fatty and/or fibrous tissue replaced the AV node in 50% of cases while in group B in 14%. The main bundle was replaced by fatty and/or fibrous tissue in 44% in group A cases and 10% in group B. Intimal proliferation and fibromuscular dysplasia of the AV arteries in group A were correspondingly 26% and 14% and in group B 6% and 2%. Inflammation with focal and/or diffuse concentration of round cells of the AV node was detected in 54% in group A. These findings could explain a possible arrhythmia mechanism in this population.

Histologic findings of the sinus node and the perinodal area in street heroin addicts, victims of sudden unexpected death.

Sudden unexpected death is frequent in street heroin addicts. We conducted a histologic study of the sinus node (SN) to offer some evidence about the possible arrhythmogenic cause of death. Postmortem coronary angiography and microscopic examination of the SN and the perinodal area were performed in 50 heroin addicts (group 1) and in 50 nonaddicts (group 2), all men (16-40 years old). In heroin addicts, fatty and/or fibrous tissue replaced SN tissue in 21 cases (42%). Perinodal infiltration was found in 15 cases (30%). Fibromuscular dysplasia in branches of the sinus node artery (SNA) was found in eight cases (16%). Inflammation with focal and/or diffuse concentration of round cells was detected in the SN in 22 cases (44%). Old mural thrombi were also found in 13 cases (26%). The histologic changes in the SN and perinodal area offer an explanation about the possible mechanism of arrhythmia and sudden death in this population.

Post mortem coronary angiographic visualization of a rare sinus node artery anatomical variant.

The incidence of sinoatrial artery variants and their significance have been repeatedly reported in the literature. Herein we describe a rare post mortem angiographic finding which concerns a unique and previously unreported case where the sinus node artery had an abnormal origin from the proximal conus artery. Although it was asymptomatic, any possible involvement with invasive or surgical procedures and its clinical consequences should be considered.

Sinus node artery originating from the posterior part of the right coronary artery.

PURPOSE: The purpose of the study was to examine the anatomical variations of the sinus node artery (SNA). METHODS: Gross anatomical examination, angiographic evaluation and if necessary dissection were performed in 200 human hearts derived from victims of various accidents. RESULTS: The SNA was a branch of the right coronary artery in 118 [59%] cases, the left circumflex in 78 [39%] cases and both coronary arteries in 4 [2%] cases. In one subject, the SNA was found to arise from the distal part of the right coronary artery. CONCLUSIONS: In our case, the sinus node was perfused by a SNA arising from the mid-posterior segment of the right coronary artery. Knowledge of this anatomical variation is useful for anatomists and of clinical significance for the interventional cardiologists and mainly for the cardiac surgeons in planning the surgical procedures.

Variation in the blood supply of the sinus node.

PURPOSE: The purpose of the study was to examine the anatomical variations in the blood supply to the sinus node. METHODS: Gross anatomical examination and angiographic evaluation were performed in 400 human hearts derived from victims of various accidents. RESULTS: The sinus node artery was a branch of the right coronary artery in 245 cases, the left circumflex in 147 cases, and both coronary arteries in 8 cases. In one subject, two sinus node arteries were found to arise from the left circumflex artery, a finding never reported before. CONCLUSIONS: Anatomic and postmortem angiographic findings of a previously unreported case where the sinus node is perfused by two sinus node arteries originating from the left circumflex coronary artery are demonstrated. Knowledge of this anatomical variation is useful for anatomists and of clinical significance for the interventional cardiologists and mainly for the cardiac surgeons in planning the surgical procedures.

A secret pathway of the sinus node artery.

Anatomic and postmortem angiographic findings of a previously unreported case of common origin of the left circumflex (LCX) and the sinus node (SN) arteries, from the left main (LM) coronary artery were demonstrated. Knowledge of this anatomical variation, although it does not give rise to symptoms, is essential for anatomist and mainly for the interventional cardiologists and cardiac surgeons for their procedures.

Histological recognition and classification of the atrioventricular node artery variants: a new approach.

BACKGROUND: There is a controversy in the literature concerning the origin, course, and distribution of the atrioventricular (AV) node artery. METHODS: Postmortem coronary angiography, dissection, and microscopic examination were performed in 100 human hearts specimens, providing anatomical, histological, and postmortem angiographic features of the AV node artery. RESULTS: Two anatomical types of AV node artery, depending on its length (long-short), were found. "Long-length" (LL) AV node artery supplied with blood almost all the AV conducting tissue in 72 cases. It consisted of a horizontal and descending part ending in two branches. "Short-length" (SL) AV node artery had only a horizontal part, perfusing exclusively the AV node and several times the nonpenetrating main bundle of His. In 67 of 100 cases, the AV arteries were arising from the right coronary artery, distal to the posterior descending (PD) artery. The AV node artery never originated from the PD artery. In 54 of 100 cases, it passed under the coronary sinus (CS) and in the remaining 46 it passed underneath the right atrium endocardium. CONCLUSIONS: The above-described postmortem coronary angiographic findings are essential for interventional cardiologists and cardiac surgeons. Damage to the LL or SL type of AV node artery may cause severe or limited AV conduction abnormalities, respectively. Furthermore, the course of AV node artery under the CS makes it susceptible to injuries provoked by diagnostic or therapeutic procedures involving the CS area.

Post-mortem angiographic and histologic findings of coronary artery fibromuscular dysplasia.

The present report highlights on exceptional angiographic and histologic features of coronary artery fibromuscular dysplasia in a young man complaining of chest discomfort during strenuous exercise. The striking features of fibromuscular dysplasia were the relative proximal localization of the lesion in left anterior descending coronary artery, the extensive length of the lesion, and the exclusive involvement of the intima producing a diffuse regular narrowing lesion. An eccentric intimal proliferation of the small left anterior descending coronary artery branches along their epicardial and intramural course was additionally demonstrated. No involvement of other coronary arteries or arteries of any other organs was observed.

Kugel's artery: an anatomical and angiographic study using a new technique.

In this study, we tried to resolve the confusion in the literature regarding the existence and course of Kugel's artery. With the aid of a new technique, we studied 100 human hearts ex vivo by radiography and by direct observation through dissection, to demonstrate anatomical and postmortem angiographic findings of Kugel's artery. Kugel's artery was found in only 6 hearts out of 100 (6%). It originated from the proximal left circumflex artery and ended in the right coronary artery in 2 cases; from the right coronary artery and ended in the same artery in 2 cases; from the left circumflex artery and ended in the same artery in 1 case; and from the right coronary artery through the sinus node artery, ending in the left circumflex artery, in 1 case. In all 100 hearts, an anastomotic network of small atrial branches was found in the same area (lower portion of the interatrial septum), connecting the large vessels indirectly. Branches of the sinus node artery in all hearts, and of the atrioventricular node artery in 66 hearts, participated in this network. Our procedure showed the detailed course of Kugel's artery and its course independent from the atrioventricular node artery and from the anastomotic network. In conclusion, in all cases an anastomotic network of small atrial branches courses through the lower interatrial septum and connects indirectly the proximal and distal ends of the larger coronary arteries. Kugel's artery provides an additional direct arterial anastomosis in the same area in 6% of the hearts.

Histologic findings in left ventricle papillary muscle arteries from human hearts.

We describe original histologic findings of left ventricle papillary muscle (LVPM) arteries in people under 30 years of age. We examined 666 samples taken from the tip, mid-portion and base of papillary muscles in 56 males and 55 females, as well as several samples from the rest of the left ventricle. The number of smooth muscle cells (SMC) in the tunica media of the LVPM arteries led us to divide the samples examined into three groups: (i) group 1, 355 samples (53%) with a normal number of SMC and a normal lumen (the number of group 1 samples increased from the tip (21%) to the base (47%)); (ii) group 2, 252 samples (38%) with a mild to moderately increased number of SMC (the number of these samples decreased from the tip (44%) to the base (22%)); and (iii) group 3, 59 samples (9%) with abundant SMC that were more than twofold greater in size and number of normal arteries, in contrast with the other two groups. The shape of the SMC in group 3 samples was round and the extremely narrow, centrally located lumen of these SMCE had a round or oval shape. These changes were restricted only to papillary muscle arteries and the number of group 3 samples decreased from the tip (63%) to the mid-portion (37%). No inflammatory reaction or chronic ischemic changes were found in the LVPM arteries and surrounding area. The SMC changes in groups 2 and 3 were found in subjects aged more than 2 months. These findings will provide anatomists, cardiologists, pathologists and physiologists with valuable knowledge and will trigger further investigation into the etiology of the structural changes observed and their evolution with age.

Original histologic findings in arteries of the right ventricle papillary muscles in human hearts.

In this study we describe original histologic findings of the right ventricle papillary muscle (PM) arteries in people under 30 years old. We examined 666 samples taken from the tip, mid-portion, and base of the PM in 56 males and 55 females, as well as samples from the rest of the right ventricle. The amount of smooth muscle cell (SMC) fibers in the tunica media (TM) led to their division into three groups: Group 1: 351 samples (53%); normal amount, normal lumen. The amount of SMCs increased from the tip (20%) to the base (48%). Group 2: 226 samples (34%); mild to moderately increased amount of SMCs, with narrowness, eccentric displacement, and uneven lumen shape. They decreased from the tip (42%) to the base (23%). Group 3: 89 samples (13%), with abundant SMCs that duplicated the arterial size, contrary to the other two groups. Their shape was round and their extremely narrow, centrally located lumen had a round or oval shape. These changes were restricted only to PM arteries and decreased from the tip (65%) to the mid-portion (35%). This type of artery predominated compared to the other two groups, probably because of the narrow lumen. No inflammatory reaction or chronic ischemic changes were found in the PM and its arteries. The SMC changes in groups 2 and 3 were found in subjects older than 2 months. The above findings will provide anatomists, cardiologists, and physiologists with valuable knowledge.