Images of persistent left superior vena cava draining directly into left atrium and secundum-type atrial septal defect.

The images of persistent left superior vena cava with the absence of the right superior vena cava are presented in a patient with the diagnosis of secundum-type atrial septal defect.

Atresia of the coronary sinus ostium to the right atrium with a persistent left superior vena cava / Atresia del ostium del seno coronario en el atrio derecho con una vena cava superior izquierda persistente

The coronary sinus has lately assumed an important role in the cardiologic clinic once it has been widely used in invasive procedures of the heart. Commonly, it is used during the electrodes implants for the epimiocardic monitoring of the cardiac rhythm, through a biventricular pace maker. These invasive procedures are not possible in hearts with an atresic coronary sinus ostium. In the presence of this anomaly, another may occur: the development of the "Marchal" vein which is a remaining of the left superior vena cava (LSVC). This happens so that the venous blood from the heart can drain into the right atrium, by a communication between the LSVC and the left brachiocephalic vein. The presence of a LSVC brings difficulties when performing an invasive procedure in order to access the right atrium through the superior vena cava, usually done in the cardiologic clinic. Moreover, the LSVC crossing over the left atrium is vulnerable to cardiovascular surgical interventions, confirmed by clinical reports. In the present study, 400 formalin fixed hearts from male cadavers, aged between 35 and 80 years, were investigated, particularly for the anatomy of the coronary sinus. The obliterated ostium of the coronary sinus to the right atrium associated with a persistent LSVC was present in only one (0.25 percent). We performed a diameter study of these structures since they were dilated due to the venous blood from the heart draining into the right atrium, by a communication between the LSVC and the left brachiocephalic vein. We also perform a literature review of these cases and discuss our finding in relation to its clinical importance.

El seno coronario recientemente ha asumido un papel importante en la clínica cardiológico, siendo ampliamente utilizado en procedimientos invasivos del corazón. Comúnmente, se utiliza en los implantes de los electrodos para el monitoreo epimiocárdico del ritmo cardiaco, a través de un ritmo biventricular establecido. Estos procedimientos invasivos no son posibles en los corazones con una atresia del ostium del seno coronario. En presencia de esta condición, se puede producir otra anomalía: el desarrollo de la vena de "Marchal" la cual es un vestigio de la vena cava superior izquierda (VCSI). Esto provoca que la sangre venosa del corazón pueda drenar en el atrio derecho, por una comunicación entre la VCSI y la vena braquicefálica izquierda. La presencia de una VCSI trae dificultades a la hora de realizar un procedimiento invasivo con el fin de acceder al atrio derecho a través de la vena cava superior, usualmente hecho en la clínica cardiológica. Por otra parte, el cruzamiento de la VCSI sobre el atrio izquierdo es vulnerable en las intervenciones quirúrgicas cardiovasculares, confirmado por informes clínicos. En el presente estudio, 400 corazones fijados en formalina provenientes a cadáveres de sexo masculino, con edades comprendidas entre los 35 y 80 años, fueron investigados, en particular por la anatomía del seno coronario. El ostium obliterado del seno coronario al atrio derecho asociado con una VCSI persistente estuvo presente en sólo una muestra (0,25 por ciento). Se realizó un estudio del diámetro de estas estructuras dilatadas debido a que la sangre venosa drena desde el corazón hacia el atrio derecho, por una comunicación entre la VCSI y la vena braquicefálica izquierda. También se realiza una revisión de la literatura de estos casos y se discuten nuestros hallazgos en relación con su importancia clínica.

Differential expression of connexin43 gap junctions in cardiomyocytes isolated from canine thoracic veins.

We investigated the phenotypic features of cardiomyocytes, including the gap junctions, in the myocardial sleeve of thoracic veins. Single cardiomyocytes, isolated from the canine pulmonary veins (PV) and superior vena cava (SVC) using digestive enzymes, were examined by immunoconfocal microscopy using antisera against connexin43 (Cx43), Cx40, and other cell markers. The results showed that isolated cardiomyocytes displayed rod shapes of various sizes, ranging from <50 microm to >200 microm in length, and all the cells expressed alpha-actinin and vinculin. Gap junctions made of various amounts of Cx43 and Cx40 were found at the cell borders. These two connexins were extensively co-localized. Comparison between the thoracic veins showed that cells of the SVC contained more Cx43 gap junctions (total Cx43 gap junctions area per cell surface area, 4.0 +/- 0.2% vs 1.5 +/- 0.2%; p<0.01). In addition, for single-nucleus cells, those from the PV were longer (103.7 +/- 3.6 vs 85.0 +/- 3.1 microm; p<0.01) but narrower (14.4 +/- 0.5 vs 16.9 +/- 0.9 microm; p<0.01). In conclusion, canine thoracic veins contain cardiomyocytes with differences in shape and gap junctions, suggesting that the electrical conduction properties may be different between the thoracic veins.

Dilated coronary sinus in prenatal echocardiography; identification, associations and outcome.

The dilated coronary sinus (DCS) has only recently been clearly visualised in the fetus due to progress in prenatal echography. This is a retrospective study of 22 fetuses presenting with DCS revealed by prenatal echography. We report the circumstances leading to the detection of a DCS and the neonatal outcome of these fetuses. The coronary sinus was defined as dilated depending on its visualisation in cross-section from the '4 chamber' view, as well as a pseudo inter-atrial septal defect from a more posterior view. In each case the gestational age, circumstances of detection, associated anomalies and postnatal outcome are reported. The circumstances were: evaluation of a clearly identified DCS in four cases and during detailed fetal echocardiography because of suspected congenital heart disease in 18 cases. Five cases were associated with a cardiac anomaly, three with an extracardiac anomaly, six with both cardiac and extracardiac anomaly and eight were isolated. Postnatal outcome was related to the associated anomaly. In conclusion, it is important that the echography image be correctly interpreted, as a DCS often implies possible associated defects and therefore affects prognosis. When not associated with other anomalies this condition is not considered serious.

Phenotyping transgenic embryos: a rapid 3-D screening method based on episcopic fluorescence image capturing.

We describe a technique suitable for routine three-dimensional (3-D) analysis of mouse embryos that is based on episcopic fluorescence images captured during serial sectioning of wax-embedded specimens. We have used this procedure to describe the cardiac phenotype and associated blood vessels of trisomic 16 (Ts16) and Cited2-null mutant mice, as well as the expression pattern of an Myf5 enhancer/beta-galactosidase transgene. The consistency of the images and their precise alignment are ideally suited for 3-D analysis using video animations, virtual resectioning or commercial 3-D reconstruction software packages. Episcopic fluorescence image capturing (EFIC) provides a simple and powerful tool for analyzing embryo and organ morphology in normal and transgenic embryos.

Heterogeneity of myocardial sleeve morphology and gap junctions in canine superior vena cava.

BACKGROUND: The myocardial sleeve of the superior vena cava (SVC) has been identified as a potential initiating focus in atrial fibrillation, but information on cell-to-cell linkage at this site is lacking. METHODS AND RESULTS: We examined the SVC in 8 dogs by immunoconfocal and electron microscopy. Cardiomyocytes outlined with vinculin and bearing striations positive for alpha-actinin are found in the proximal segment of the SVC. These cells, grouped in bundles of various orientations according to location, extend cephalically as far as 3 cm from the right atrium (RA)-SVC junction. Comparison between the junctional level and the level 2 cm distal shows that the myocardial layer in the latter is thinner and not as compact and is composed of longer cells (87.3+/-15.7 versus 71.6+/-14.4 micrometer, P<0.01). Gap junctions made of connexin43 (Cx43), Cx40, and Cx45 are aggregated mainly at the intercalated disks, and colocalization of connexins is a common feature throughout the myocardial sleeve. Areas of atypical expression exist, however, characterized by a center of abundant Cx43 labels surrounded by a periphery of scattered tiny Cx40-labeled spots. Although in the ventral subluminal compact myocardial layer, individual cells at both levels are surrounded by similar numbers of cells, the number of aggregation of labeled gap junctions at the distal level is less (2.3+/-0.6 versus 3.7+/-0.9, P<0.01). In addition, electron-microscopic examination demonstrates that the gap junctions at the distal level are smaller in size (0.37+/-0.30 versus 0.55+/-0.34 micrometer, P<0.01). CONCLUSIONS: The myocardial sleeve in the canine SVC is a heterogeneous structure, which could potentially form a substrate for heterogeneity of electrical coupling.

Ultrastructural study of the sinus venosus in embryos of the dogfish (Scyliorhinus canicula).

An ultrastructural study of the development of the sinus venosus has been carried out on seven embryos of the dogfish (Scyliorhinus canicula L.) between 10.5 and 69 mm of total length (TL). The sinus venosus appears at the end of the looping process of the cardiac tube, namely in the 10.5 mm embryo, when the heart reaches its adult tetracameral S-form. The endocardium of the smallest embryo is constituted of a single layer of cubic cells. In larger embryo, these cells progressively acquire a squamous appearance as well as electron-dense cytoplasmic inclusions. The subendocardium is progressively populated by ganglion cells, Schwann cells and bundles of amyelinic fibers that can first be recognised in the embryo of 34 mm TL. Some subendocardial mesenchymal cells located in earlier embryos close to the entrance of the ducts of Cuvier might be their ectomesenchymal progenitors. The myocardium is initially constituted of a single layer of cubic cells. In the embryos of 19, 27 and 34 mm TL, the myocardium becomes multilayered, and the myocardiocytes develop myofibrils randomly arranged throughout the sarcoplasm. In later embryos, the myocardiocytes are innervated and arranged in oval bundles surrounded by a basal lamina. The epicardium covers the sinus venosus by the retrograde migration of the epithelium already established around the atrioventricular groove and, in a lesser degree, by the adhesion of mesothelial cells that are floating free in the pericardial cavity. This process has finished in the embryo of 34 mm TL. The differentiation of the sinus venosus (including the endocardial and myocardial differentiation as well as the epicardial covering) progresses in an anteroventral-posterodorsal direction.

Structural characteristics of the superior venae cavae wall at the intrapericardium segment in adults and aging individuals.

The authors admit that the conjunctive-muscular constitution of the walls of the superior venae cavae throughout the length of the intrapericardium segment and the debouchement in the right atrium, associated with the presence of a myocardium sheath can be made up of a functional device of sphincter form able to act on the control of the blood flow to the interior of the arterial chamber as well as stopping blood flow during the arterial systole. The fixation of the venous wall to the deep chamber of the serous pericardium, contributes to growth in resistance during the elevation of venous pressure, making possible the preservation of integrity of the superior venae cavae. The expansion of fasciculi of nodal fibers in the right wall of the superior venae cavae permits that the unlocked impulse in the S-A node also reaches the vascular wall contributing to the shortening and diminuation in caliber of the vein.

A histological study of the cardiac muscle of the human superior and inferior venae cavae.

Human superior and inferior venae cavae at the orifices to hearts obtained from two cadavers were histologically examined with regard to the distribution of cardiac muscle fibers in their walls. The superior vena cava contained cardiac muscle fibers together with smooth muscle fibers. The cardiac muscle fibers were distributed uninterruptedly from the atrium to the root of the azygos vein, covering a length of 45 mm. Cardiac myocytes were present outside the smooth muscle and coursed in bundles longitudinally, obliquely, or circularly. Cardiac myocytes occupied one to two thirds of the wall thickness, but decreased in amount toward the periphery. The inferior vena cava also contained both cardiac and smooth muscle fibers. The cardiac muscle fibers extended continuously, covering a distance of 18 mm from the atrium to a level just under the diaphragm. Their fibers were bundled, running circularly or obliquely, and being more abundant in the anterior wall than in the posterior. From these findings, the venae cavae close to the atrium are histologically regarded as an extension of the atrium. The venae cavae close to the atrium probably contract together with the atrium and work as a functional valve that contributes to the pumping mechanism of the heart.

Continuous intravenous infusion in the unrestrained rat--procedures and results.

1. A method of continuous infusion in the unrestrained rat is described, which provides a scientifically acceptable and easily maintained rodent model for use in toxicological investigations. 2. Sprague Dawley SPF rats had cannulas implanted into the vena cava via the femoral vein, and were continuously infused with physiological saline for a total of 28 or 90 days. 3. The results indicate that there was no change in body weight, food consumption, clinical observations or clinical biochemistry of infused rats when compared to non-infused rats. There were small changes in haematological parameters, however none were toxicologically significant. Urinary volume was increased and urinary specific gravity and osmolality were decreased. At macroscopic and microscopic examination there were findings of scar formation associated with the area of surgery and minimal irritation in the area of the vena cava which accommodated the cannula. 4. These results indicate that implantation of a cannula into the vena cava of a rat and subsequent continuous intravenous infusion of physiological saline produces no toxicological adverse effects over a period of 90 days. Consequently, this model can be recommended for the continuous intravenous administration of test substances to rats.

Cardiac musculature of the cranial and caudal venae cavae and the pulmonary vein in the fowl.

The cardiac musculature of cranial and caudal venae cavae and pulmonary vein was examined to clarify its distribution pattern in the fowl using both light and electron microscopies. The musculature was distributed from the heart to the root of subclavian vein in the cranial vena cava, to the cranial margin of the liver in the caudal vena cava, and to the left and right distal pulmonary veins in the pulmonary vein, respectively. Judging from the morphology and distribution pattern in the venous wall, the cardiac musculature in the fowl is thought to share the same phylogenic origin with that in mammals. The ultrastructure of cardiac myocytes including transitional cells in the cranial vena cava and the pulmonary vein resembled that of atrial myocytes. While, the typical specialized myocytes such as Purkinje fiber were found in the caudal vena cava of the fowl.

[Leiomyosarcoma of the superior vena cava. Case report]. / Leiomyosarcome de la veine cave supérieure. A propos d'un cas.

Leiomyosarcoma of the blood vessels is a rare malignant tumor, and its localization in the superior vena cava is exceptional. We had the opportunity to study such a case and we compared our clinical, histological and ultrastructural results with those of 5 other reported cases.

Angiotensin II generation in the rat vena cava: stimulation of local synthesis by beta-adrenoceptor activation.

There is considerable evidence to suggest that isolated tissues have the capacity to generate angiotensin II and that angiotensin II thus generated may enhance noradrenergic neurotransmission. In the present study the possibility that there may be local formation of angiotensin II within the rat vena cava and its consequence to noradrenergic transmission has been investigated. The angiotensin II precursors, angiotensin I and a synthetic tetradecapeptide renin substrate, each enhanced the stimulation-induced efflux of radioactivity from tissues previously incubated with 3H-noradrenaline. The effects of angiotensin I were blocked by the converting enzyme inhibitor captopril and the receptor antagonist saralasin, indicating local conversion to angiotensin II. The effect of the tetradecapeptide was blocked by saralasin, but not by captopril, suggesting either a direct effect of this peptide or conversion to angiotensin II by a pathway not involving angiotensin converting enzyme. The beta-adrenoceptor agonist isoprenaline enhanced noradrenergic transmission in the rat vena cava, relaxed guinea-pig trachea precontracted with carbachol and increased heart rate in rat isolated atria. Captopril and saralasin blocked the effect of isoprenaline in the vena cava, but did not alter its effects in the atria or trachea. This suggests that in the rat vena cava the facilitation of noradrenergic transmission by isoprenaline may involve stimulation of local angiotensin II production.

Atrial natriuretic factor in the vena cava and sinus node.

We investigated the localization of atrial natriuretic factor (ANF) mRNA and of immunoreactive ANF in the vena cava and sinus node of rat and, for comparative purposes, in atria and ventricles. In situ hybridization with an ANF cRNA probe revealed that the supradiaphragmatic portion of the inferior vena cava contains almost as much mRNA as the atria, whereas the levels were less in the superior vena cava and higher than in ventricles in the sinus node. Immunoreactive ANF (high Mr form) was found to be 22 times less abundant in the supradiaphragmatic vena cava and 148 times less abundant in the superior vena cava than in atrial cardiocytes. The wall of the supradiaphragmatic portion of the vena cava and the valve (eustachian valve) that separates the atrial cavity from that of the vein are made up of atrial-like cardiocytes containing secretory granules. The subendothelial area of the superior vena cava also contains atrial-like cardiocytes with secretory granules, whereas the outer portion of the vein is made up of "transitional cells" without or with only a few secretory granules. Secretory granules in the vena cava and nodal cells, as well as transitional cells, contain immunoreactive ANF. With immunocryoultramicrotomy, virtually all cells, whether atrial-like, transitional, or nodal, and even those without secretory granules, were found to contain immunoreactive ANF in their Golgi complex and in secretory vesicles in the vena cava and in the sinus node.

Contribuiçäo ao estudo morfológico das estruturas que compöem a transiçäo cavo-atrial no homem / Contribution to the morphologic study of the structures that form the superior the cavo-atrial transition in the man

Os autores se propöesm a estudar a disposiçäo espacial do tecido fibro-muscular na transiçäo cavo-atrial superior. Mostram que o componente muscular da crista terminal projeta-se estratigraficamente na porçäo intra-pericárdica da veia cava superior onde o componente muscular liso é pouco expressivo. Observam ainda que os tecidos colágeno e elástico acompanham de modo geral a disposiçäo e a estratigrafia muscular