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Kesieme EB, Buchan KG. Clinical anatomy of the coronary venous system and relevance to retrograde cardioplegia and cardiac electrophysiological interventions. Clin Anat 2024. [PMID: 38867517 DOI: 10.1002/ca.24195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 05/11/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
Anomalies of coronary venous system, the valve of the coronary sinus (Thebesian valve) and other cardiac malformations may make interventions through the coronary sinus difficult. These variants may pose a challenge in cannulating the coronary sinus for retrograde cardioplegia and for interventions performed through the coronary sinus by cardiac electrophysiologist/interventional cardiologist. Retrograde cardioplegia is an established method of myocardial protection with advantages, indications, and complications. A good knowledge of the anatomy of the coronary sinus and its variants is important in understanding the difficulties encountered while cannulating the coronary sinus for the delivery of retrograde cardioplegia, cardiac resynchronization therapy, treatment of arrhythmias, and percutaneous mitral valve annuloplasty.
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Affiliation(s)
| | - Keith Gunn Buchan
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
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2
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Wang Y, Yin X. Modelling coronary flow and myocardial perfusion by integrating a structured-tree coronary flow model and a hyperelastic left ventricle model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107928. [PMID: 38000321 DOI: 10.1016/j.cmpb.2023.107928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND OBJECTIVE There is an increasing demand to establish integrated computational models that facilitate the exploration of coronary circulation in physiological and pathological contexts, particularly concerning interactions between coronary flow dynamics and myocardial motion. The field of cardiology has also demonstrated a trend toward personalised medicine, where these integrated models can be instrumental in integrating patient-specific data to improve therapeutic outcomes. Notably, incorporating a structured-tree model into such integrated models is currently absent in the literature, which presents a promising prospect. Thus, the goal here is to develop a novel computational framework that combines a 1D structured-tree model of coronary flow in human coronary vasculature with a 3D left ventricle model utilising a hyperelastic constitutive law, enabling the physiologically accurate simulation of coronary flow dynamics. METHODS We adopted detailed geometric information from previous studies of both coronary vasculature and left ventricle to construct the coronary flow model and the left ventricle model. The structured-tree model for coronary flow was expanded to encompass the effect of time-varying intramyocardial pressure on intramyocardial blood vessels. Simultaneously, the left ventricle model served as a robust foundation for the calculation of intramyocardial pressure and subsequent quantitative evaluation of myocardial perfusion. A one-way coupling framework between the two models was established to enable the evaluation and examination of coronary flow dynamics and myocardial perfusion. RESULTS Our predicted coronary flow waveforms aligned well with published experimental data. Our model precisely captured the phasic pattern of coronary flow, including impeded or even reversed flow during systole. Moreover, our assessment of coronary flow, considering both globally and regionally averaged intramyocardial pressure, demonstrated that elevated intramyocardial pressure corresponds to increased impeding effects on coronary flow. Furthermore, myocardial blood flow simulated from our model was comparable with MRI perfusion data at rest, showcasing the capability of our model to predict myocardial perfusion. CONCLUSIONS The integrated model introduced in this study presents a novel approach to achieving physiologically accurate simulations of coronary flow and myocardial perfusion. It holds promise for its clinical applicability in diagnosing insufficient myocardial perfusion.
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Affiliation(s)
- Yingjie Wang
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom.
| | - Xueqing Yin
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
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3
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Kim J, Kim DH, Kim K, Oh D, Yoon J. Non-electrocardiography- and electrocardiography-gated computed tomography angiography for the evaluation of feline coronary arteries. Front Vet Sci 2022; 9:952412. [PMID: 35990260 PMCID: PMC9382086 DOI: 10.3389/fvets.2022.952412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Few studies have directly compared the clinical feasibility of electrocardiography-gated and non-electrocardiography-gated multidetector computed tomography for evaluating coronary arteries in veterinary medicine. We aimed to characterize and visualize feline coronary arteries using these two imaging modalities. We hypothesed that ECG-gated MDCT is superior to or advantageous to the non-ECG gated. Methods This prospective, controlled, comparative pilot study examined six client-owned cats (five clinically normal and one with hypertrophic cardiomyopathy) using non-electrocardiography-gated and retrospective electrocardiography-gated scans. Optimal non-electrocardiography scan timing or electrocardiography-gated R-R reconstruction interval for coronary artery visualization was determined. The degree of opacification and sharpness of proximal coronary branches was subjectively graded; coronary dominance, left coronary artery branching types, and the diameter and length of coronary artery branches were also assessed. Results Non-electrocardiography-gated images provided the least information on the bilateral coronary artery ostium and proximal segments, while electrocardiography-gated images clarified the detailed course of the main coronary branches at diastole in all cats. The degree of opacification and sharpness of the coronary arteries was subjectively evaluated as good/excellent in all cats. Coronary dominance (left: four; right: two) and left coronary artery branching types (three different patterns, two additional tortuous branches) varied. Body weight and sex were not significantly associated with coronary artery length or diameter. Vertebral heart score positively correlated with the right coronary artery and negatively correlated with the left main coronary artery. Clinical significance Electrocardiography-gated multidetector computed tomography provides images with adequate resolution to identify the anatomy of feline coronary arteries. Detailed morphological knowledge of feline coronary vessels will enable novel diagnostic and therapeutic methods in veterinary medicine.
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Affiliation(s)
- Junyoung Kim
- Helix Animal Medical Center, Seoul, South Korea
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Dae-Hyun Kim
- College of Veterinary Medicine, Chungnam National University, Daejeon, South Korea
| | - Kitae Kim
- BIEN Animal Medical Center, Bucheon, South Korea
| | - Dayoung Oh
- BIEN Animal Medical Center, Bucheon, South Korea
| | - Junghee Yoon
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
- *Correspondence: Junghee Yoon
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Transcatheter Coronary Sinus Interventions. JACC Cardiovasc Interv 2022; 15:1397-1412. [PMID: 35863788 DOI: 10.1016/j.jcin.2022.05.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
Abstract
The coronary sinus has become a popular route for an increasing number of innovative transcatheter interventions to treat coronary and structural heart diseases. However, interventional cardiologists have limited experience with the cardiac venous system and its highly variable anatomy. In this paper, we review the anatomy of the cardiac veins as it relates to transcatheter interventions. We also provide a contemporary overview of the emerging coronary sinus-based transcatheter therapies and their growing literature.
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5
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Martins VF, Hsiao A, Kligerman S, Brouha SS. Left Circumflex Coronary Artery-to-Coronary Sinus Fistula with Coronary Sinus Ostial Atresia and a Persistent Left Superior Vena Cava in an Adult Patient. Radiol Cardiothorac Imaging 2022; 4:e210249. [PMID: 35782758 PMCID: PMC8893212 DOI: 10.1148/ryct.210249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 06/15/2023]
Abstract
Understanding of coronary sinus (CS) anatomy and abnormalities is of critical importance due to their use in interventional procedures. Herein, the authors report a rare case of an asymptomatic 72-year-old man with a left circumflex coronary artery-to-CS fistula, together with CS ostial atresia and persistent left superior vena cava. These findings are described using both cardiac CT angiography and MRI with four-dimensional flow for anatomic and functional assessment. Keywords: Cardiac, Coronary Sinus, Aneurysms, Fistula, CT Angiography, MR Imaging Supplemental material is available for this article. © RSNA, 2022.
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6
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Maddali MM, Thomas E, Patel MH, Al-Maskari SN. Third Atrial Chamber. J Cardiothorac Vasc Anesth 2021; 36:2825-2828. [DOI: 10.1053/j.jvca.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/11/2022]
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7
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A Man with Chronic Asymptomatic Hypoxemia. Ann Am Thorac Soc 2021; 18:1728-1732. [PMID: 34596495 DOI: 10.1513/annalsats.202007-902cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Selcuk SN, Ertugrul İ, Karagoz T. Giant diverticulum of coronary sinus with multiple accessory pathways treated with catheter ablation. Cardiol Young 2021; 32:1-4. [PMID: 34551842 DOI: 10.1017/s1047951121003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coronary sinus abnormalities are usually associated with arrhythmia disorders when symptomatic. We report a 5-year-old 14 kg patient with a giant diverticulum of coronary sinus and Wolff-Parkinson-White syndrome. Catheter ablation therapy was decided during follow-up due to inadequate response to multidrug therapy. Posteroseptal and left posterolateral accessory pathways were established and radiofrequency ablation was performed successfully through coronary sinus.
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Affiliation(s)
- Sinem N Selcuk
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlker Ertugrul
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Karagoz
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Słodowska K, Hołda J, Dudkiewicz D, Malinowska K, Bolechała F, Kopacz P, Koziej M, Hołda MK. Thickness of the left atrial wall surrounding the left atrial appendage orifice. J Cardiovasc Electrophysiol 2021; 32:2262-2268. [PMID: 34245483 DOI: 10.1111/jce.15157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the thickness of the left atrial wall surrounding the left atrial appendage (LAA) orifice. METHODS AND RESULTS The tissue thickness around the LAA orifice was measured at four points (superior, inferior, anterior, and posterior) in 200 randomly selected autopsied human hearts. The thickest tissue was observed at the anterior point (3.17 ± 1.41 mm), followed by the superior (2.47 ± 1.00 mm), inferior (2.22 ± 0.80 mm) and posterior (2.22 ± 0.83 mm). The chicken wing LAA type was associated with the lowest thickness at the superior point compared to the cauliflower and arrowhead shapes (p = .024). In hearts with an oval LAA orifice, the atrial wall was significantly thicker in all points than in specimens with a round LAA orifice (p > .05). Both the LAA orifice anteroposterior diameter and orifice surface area were negatively correlated with the tissue thickness in the anterior (r = -.22, p = .004 and r = -.23, p = .001) and posterior points (r = -.24, p = .001 and r = -.28, p = .005). Endocardial surface roughness was commonly in the inferior pole of the LAA orifice (75.5% of cases), while they are much less prevalent in other sectors around the orifice (anterior: 17.5%), superior: 4.0%, and posterior: 1.5%). CONCLUSIONS Although a significant heterogeneity in the atrial wall thickness around the LAA orifice was observed, the thickness in the respective points is quite conservative and depends only on LAA orifice size and shape, as well as LAA body shape. Thin atrial wall and endocardial surface roughness might challenge invasive procedures within this region.
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Affiliation(s)
- Katarzyna Słodowska
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jakub Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Damian Dudkiewicz
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Karolina Malinowska
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Filip Bolechała
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Kopacz
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Department of Forensic Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Mateusz K Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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Blissett S, Lin S, Mahadevan V, Ordovas K. Adult Presentation of Congenital Heart Disease. Semin Roentgenol 2020; 55:251-263. [PMID: 32859342 DOI: 10.1053/j.ro.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah Blissett
- Department of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Shezhang Lin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Vaikom Mahadevan
- Department of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Karen Ordovas
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA.
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11
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Persistent left superior vena cava with absent right superior vena cava in adults: CT and clinical findings. Jpn J Radiol 2020; 38:1046-1051. [PMID: 32666181 DOI: 10.1007/s11604-020-01013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Persistent left superior vena cava (PLSVC) with absent right superior vena cava (ARSVC) is rare. We evaluated CT and clinical findings of adults with ARSVC. MATERIALS AND METHODS Our study included 11 adults with ARSVC (mean age, 63 ± 17 years). We evaluated CT findings of the azygos vein system and coronary sinus (CS) using thin slice data of > 64 MDCT. Arrhythmia and congenial heart disease were assessed. We compared the CS diameters between the ARSVC group and the control group of 120 adults with normal vena cava (mean age, 60 ± 4 years). RESULTS Adults with ARSVC had no azygos vein arch and the hemiazygos vein continued to PLSVCs via the superior intercostal vein. Eight adults had arrhythmia including conduction disturbance and one arrhythmia was associated with atrial septal defect. All adults with ARSVC had dilated CS larger than 11 mm. The mean diameter of the CS in the ARSVC group was 18.4 mm, and that of the control group was 6.8 mm. CS diameter in the ARSVC group was larger than that in the control group (p < 0.001). CONCLUSION Adults with ARSVC had dilated CS and no azygos vein arch. Four adults had conduction disturbance.
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12
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Kaiser Ururahy Nunes Fonseca E, Scoppetta LRPD. Coronary Sinus Diverticulum. Radiol Cardiothorac Imaging 2019; 1:e190118. [PMID: 33778532 PMCID: PMC7977774 DOI: 10.1148/ryct.2019190118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 06/12/2023]
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13
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Lebon JS, Couture P, Colizza M, Fortier A, Rochon A, Ayoub C, Desjardins G, Deschamps A, Chamberland MÈ, Laliberté E, Bouchard D, Pellerin M. Myocardial Protection in Minimally Invasive Mitral Valve Surgery: Retrograde Cardioplegia Alone Using Endovascular Coronary Sinus Catheter Compared With Combined Antegrade and Retrograde Cardioplegia. J Cardiothorac Vasc Anesth 2019; 33:1197-1204. [PMID: 30655202 DOI: 10.1053/j.jvca.2018.11.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare myocardial protection with retrograde cardioplegia alone with antegrade and retrograde cardioplegia in minimally invasive mitral valve surgery (MIMS). DESIGN Retrospective study. SETTING Tertiary care university hospital. PARTICIPANTS The authors studied 97 MIMS patients using retrograde cardioplegia alone and 118 MIMS patients using antegrade and retrograde cardioplegia. INTERVENTIONS The data from patients admitted for MIMS using retrograde cardioplegia (MIMS retro) between 2009 to 2012 were compared with the data from patients undergoing MIMS with antegrade and retrograde cardioplegia (MIMS ante-retro) between 2006 and 2010 (control group). Cardioplegia in the MIMS retro group was delivered solely through an endovascular coronary sinus (CS) catheter positioned under echographic and fluoroscopic guidance. Antegrade and retrograde cardioplegia was used in the MIMS ante-retro group. Data regarding myocardial infarction (MI; creatine kinase Mb, troponin T, electrocardiogram), myocardial function, and hemodynamic stability were collected for comparison. MEASUREMENTS AND MAIN RESULTS Adequate cardioplegia administration (CS pressure >30 mmHg and asystole) was attained in 74.2% of the patients with retrograde cardioplegia alone. In 23.7% of the patients, the addition of an antegrade cardioplegia was necessary. No difference was observed in the incidence of MI (0 MIMS retro v 1 for MIMS ante-retro, p = 0.3623), difficult separation from cardiopulmonary bypass, and postoperative malignant arrhythmia. No difference was found for maximal creatine kinase Mb (39.1 [28.0-49.1] v 37.9 [28.6-50.9]; p = 0.8299) and for maximal troponin T levels (0.39 [0.27-0.70] v 0.47 [0.32-0.79]; p = 0.1231) for MIMS retro and MIMS ante-retro, respectively. However, lactate levels in the MIMS retro group were significantly lower than in the MIMS ante-retro group (2.1 [1.4-3.05] v 2.4 [1.8-3.3], respectively; p = 0.0453). No difference was observed in duration of intensive care unit stay and death. MIMS retro patients had a shorter hospital stay (7.0 [6.0-8.0] v 8.0 [7.0-9.0] days; p = 0.0003). CONCLUSION Retrograde cardioplegia administration alone provided comparable myocardial protection to antegrade and retrograde cardioplegia during MIMS, but was not sufficient to achieve asystole in one-fifth of patients.
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Affiliation(s)
- Jean-Sebastien Lebon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Melissa Colizza
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Annik Fortier
- Department of Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Ayoub
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Deschamps
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Ève Chamberland
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Eric Laliberté
- Department of Clinical Perfusion, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Michel Pellerin
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
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Nguyên UC, Cluitmans MJM, Strik M, Luermans JG, Gommers S, Wildberger JE, Bekkers SCAM, Volders PGA, Mihl C, Prinzen FW, Vernooy K. Integration of cardiac magnetic resonance imaging, electrocardiographic imaging, and coronary venous computed tomography angiography for guidance of left ventricular lead positioning. Europace 2018; 21:626-635. [DOI: 10.1093/europace/euy292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthijs J M Cluitmans
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marc Strik
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Justin G Luermans
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Suzanne Gommers
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sebastiaan C A M Bekkers
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul G A Volders
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Casper Mihl
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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15
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Reply to the letter from Bhagirath et al.: Imaging for cardiac resynchronisation therapy requires cardiac magnetic resonance. Neth Heart J 2018; 26:641-642. [PMID: 30406603 PMCID: PMC6288029 DOI: 10.1007/s12471-018-1196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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16
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Tannous P, Ghelani SJ, Marshall AC, Porras D. Angiographically detectable Thebesian veins are a dynamic and reversible finding in the setting of congenital heart disease. CONGENIT HEART DIS 2017; 12:467-474. [PMID: 28294539 DOI: 10.1111/chd.12457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Angiographically detectable Thebesian veins (ThVs) are a rare finding sometimes associated with coronary steal and myocardial ischemia in adults, but there are limited data regarding prominent ThVs in the setting of complex congenital heart disease (CHD). This study represents the largest series to date describing the presence and temporal changes of angiographically detectable ThVs in children with CHD. METHODS This is a single center case series describing the clinical characteristics and coronary anatomy in children with CHD and angiographicall detectable ThVs. After identification of the index case, additional patients were identified in a prospective manner during the course of routine clinical care. We developed a qualitative scale to grade ThV burden, with changes tracked over time in the subset of patients who underwent serial cardiac catheterizations. RESULTS A total of 10 patients are included in this report. There was a predominance of female gender (8 of 10 patients), right-dominant single ventricle physiology (7 of 10 patients), and heterotaxy syndrome (6 of 10 patients). The degree and location of epicardial coronary artery tortuosity was qualitatively related to ThV burden. The subset of patients who underwent serial cardiac catheterizations demonstrate that ThV dilation can progress or regress over time. CONCLUSIONS Angiographically detectable Thebesian veins are a rare finding in patients with congenital heart disease and may represent global changes in the coronary circulation. This is the first report, adult or pediatric, to demonstrate that ThV dilation is a dynamic process capable of both progression and regression. The physiologic impact of these findings remains to be elucidated.
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Affiliation(s)
- Paul Tannous
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey C Marshall
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Diego Porras
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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17
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Xianghong LMD, Qian ZMD, Qing YMD, Jufang WMD, Qingqing DMD, Zhaojun LMD. Diagnosis with Echocardiography for Rare Cases of Anomalous Left Main Coronary Artery: Two Case Reports and Important Lessons Learned. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2017. [DOI: 10.37015/audt.2017.170003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Namdar M, Chmelevsky M, Hachulla AL, Shah DC. Precise Noninvasive ECG Mapping Derived Localization of the Origin of an Epicardial Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.003949. [PMID: 27956434 DOI: 10.1161/circep.116.003949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 08/15/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mehdi Namdar
- From the Cardiology Department (M.N., D.C.S.) and Division of Radiology (A.-L.H.), Geneva University Hospital, Switzerland; Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia (M.C.); and EP Solutions SA, Yverdon-les-Bains, Switzerland (M.C.)
| | - Mikhail Chmelevsky
- From the Cardiology Department (M.N., D.C.S.) and Division of Radiology (A.-L.H.), Geneva University Hospital, Switzerland; Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia (M.C.); and EP Solutions SA, Yverdon-les-Bains, Switzerland (M.C.)
| | - Anne-Lise Hachulla
- From the Cardiology Department (M.N., D.C.S.) and Division of Radiology (A.-L.H.), Geneva University Hospital, Switzerland; Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia (M.C.); and EP Solutions SA, Yverdon-les-Bains, Switzerland (M.C.)
| | - Dipen C. Shah
- From the Cardiology Department (M.N., D.C.S.) and Division of Radiology (A.-L.H.), Geneva University Hospital, Switzerland; Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia (M.C.); and EP Solutions SA, Yverdon-les-Bains, Switzerland (M.C.)
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Absence of coronary sinus tributaries in ischemic cardiomyopathy: An insight from multidetector computed tomography cardiac venographic study. J Cardiovasc Comput Tomogr 2016; 10:156-61. [DOI: 10.1016/j.jcct.2016.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/04/2016] [Accepted: 01/26/2016] [Indexed: 01/23/2023]
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Keir M, Wald RM, Roche SL, Oechslin EN, Horlick E, Osten MD, Benson LN, Hickey EJ, Crean AM. Does a dedicated subspecialty ACHD coronary clinic result in greater consistency in approach and reduced loss to follow-up? An evaluation of the first 3years of the Toronto Congenital Coronary Clinic for Adults. PROGRESS IN PEDIATRIC CARDIOLOGY 2015. [DOI: 10.1016/j.ppedcard.2015.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Introducer Development for Coronary Sinus Access From Parasternal Mediastinotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:202-8. [PMID: 26181586 DOI: 10.1097/imi.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Right parasternal mediastinotomy with right atriotomy has been used clinically for pacemaker insertion. A similar approach might facilitate access to the coronary sinus for biventricular pacing and other manipulations when more conventional approaches are not feasible. The primary barrier to this is lack of appropriate introducers and techniques. METHODS Anatomically derived introducers were developed in 2 anesthetized domestic pigs using data from computerized axial thoracic tomography. Each digitized tomogram defined a unique introducer shape and was constructed using 3-dimensional (3D) modeling software and printing. Each parent pig then underwent surgery demonstrating coronary sinus lead insertion, using its custom-configured introducer. Next, with institutional review board approval, 65 patients were identified who had undergone conventional endocardial coronary sinus lead insertion followed by thoracic scanning. These tomograms were used to design appropriately curved introducers for human anatomy. RESULTS Fifty-one introducer paths were defined following anatomic pathways and avoiding bends inconsistent with materials used for commercial peel-away introducers. Each path was defined by a bend and distance toward the coronary sinus ostium and a hook and twist out of plane to align with the local orientation of the coronary sinus. The average dimensions were the following: distance, 67 mm; bend angle, 47 degrees; hook angle, 39 degrees; and twist angle, 20 degrees. A prototype cannula was tested for fit in a fresh frozen postmortem human specimen. CONCLUSIONS Parasternal mediastinotomy access to the coronary sinus for cardiac resynchronization, mitral annuloplasty, and instrumentation is feasible. Human computerized tomographic scans can be used to define curvatures and dimensions for marketed introducers.
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Introducer Development for Coronary Sinus Access from Parasternal Mediastinotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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