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Périer M, Haidar HA, Sulman D, Huang F, Benamer H. [Coronary sinus reducer : Technical aspects, prevention and management of potential complications]. Ann Cardiol Angeiol (Paris) 2024; 73:101785. [PMID: 39146699 DOI: 10.1016/j.ancard.2024.101785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 08/17/2024]
Abstract
Coronary sinus reducer implantation is a percutaneous technique creating a narrowing in the coronary sinus through the implantation of an hourglass-shaped endoprosthesis. It is proposed to reduce symptoms in patients suffering from refractory angina pectoris. This innovative treatment is experiencing a major craze among interventional cardiologists. It is associated with very high procedural success rates. Complications are rare and include coronary sinus dissection or perforation and migration of the device. This review exposes the device implantation technique, the potential anatomical difficulties, the tips and tricks to overcome challenging situations. It also focuses on the prevention and management of potential complications.
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Affiliation(s)
- Matthieu Périer
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - Hachem-Ali Haidar
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - David Sulman
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Florent Huang
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Hakim Benamer
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Institut Jacques Cartier, Institut cardiovasculaire Paris Sud (ICPS) Ramsay Générale de santé, S 91300 Massy, France; Membre du Collège de Médecine des Hôpitaux de Paris, France
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2
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Efremidis M, Sousonis V, Letsas K. The ideal index to predict the site of origin of outflow tract ventricular arrhythmias. Are we there yet? J Cardiovasc Electrophysiol 2024; 35:1450-1451. [PMID: 38818575 DOI: 10.1111/jce.16332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Michael Efremidis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vasileios Sousonis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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3
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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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Ghosh SK, Priya A, Narayan RK. Raymond de Vieussens (1641-1715): connoisseur of cardiologic anatomy and pathological forms thereof. Anat Cell Biol 2021; 54:417-423. [PMID: 34373361 PMCID: PMC8693130 DOI: 10.5115/acb.21.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
Raymond de Vieussens was an exemplary anatomist who made seminal contributions in the field of cardiology. During initial part of his academic career, he adopted human dissection based experiments as medium of his research. This was in accordance with prevailing trend among anatomists during 17th century. He discovered the presence of tiny venous tributaries communicating between cardiac veins and chambers of heart (ducti carnosi/venae cordis minimae). He reported the existence of a collateral circulatory pathway between right and left coronary arterial systems (Vieussens arterial ring). He was the first to note the valve at the junction of great cardiac vein and coronary sinus (valve of Vieussens) and the prominent oval margin of the fossa ovalis (Vieussens Annulus). All his findings were associated with considerable clinical significance as evidenced in literature that followed. Vieussens accurately demonstrated the three-layered orientation of myocardium and gave a precise description of coronary arteries and their branches. At the onset of 18th century, buoyed by royal patronage from King Louis XIV of France, the second half of Vieussens illustrious career was defined by pathologic anatomy (autopsy based) and anatomo clinical correlations. This was a new trend initiated by Vieussens in anatomical research and was later adopted as a signature method by anatomists of 18th century. As a true connoisseur of cardiologic anatomy, Vieussens accurately charted the anatomo clinical correlations of cardiac tamponade, mitral stenosis and aortic regurgitation. His contributions were pivotal elements in metamorphosis of cardiology as a robust discipline of medicine in modern times.
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Affiliation(s)
- Sanjib Kumar Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Ananya Priya
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Ravi Kant Narayan
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
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Sarmiento-Cobos M, Valera R, Botero Fonnegra C, Alonso M, Rivera C, Montorfano L, Wasser E, Lo Menzo E, Szomstein S, Rosenthal RJ. Ventricular conduction improvement after pericardial fat reduction triggered by rapid weight loss in subjects with obesity undergoing bariatric surgery. Surg Obes Relat Dis 2021; 18:288-294. [PMID: 34756564 DOI: 10.1016/j.soard.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 08/12/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity is considered a major cardiovascular risk factor. The excess of pericardial fat (PF) in patients with obesity has been associated with a variety of electrocardiographic alterations. In previous studies, we demonstrated that rapid weight loss and bariatric interventions result in decreased PF. OBJECTIVES The aim of this study is to report the changes in PF after bariatric surgery and its effect on ventricular conduction. SETTING US hospital, academic institution. METHODS A linear measurement of PF thickness on computed tomography scans was obtained for 81 patients, as well as a retrospective review of electrocardiographic changes before and after bariatric surgery. We compared the changes in PF thickness and electrocardiographic components before and after procedures. Common demographics and co-morbidities were collected along with lipid profiles preoperative and postoperative. RESULTS A total of 81 patients had electrocardiograms done before and 1 year after bariatric surgery. Females comprised 67.9% (n = 55), and the average age for our population was 55.07 ± 14.17 years. Pericardial fat thickness before surgery was 5.6 ± 1.84 and 4.5 ± 1.62 mm after surgery (P = .0001). Ventricular conduction (QT and QT corrected [QTc] intervals) showed a significant improvement from 438.7 + 29 before to 426.8 + 25.3 after bariatric surgery (P = .006). We found a statistically significant association between the decrease in PF and the decrease in QTc intervals (P = .002). CONCLUSION Obesity is a risk factor for arrhythmias and sudden cardiac death. Bariatric surgery and its effect on PF produce an improvement in ventricular conduction, which may reduce the ventricular electrical instability in patients with obesity.
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Affiliation(s)
- Mauricio Sarmiento-Cobos
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Roberto Valera
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Cristina Botero Fonnegra
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Mileydis Alonso
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Carlos Rivera
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Lisandro Montorfano
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Elliot Wasser
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, Weston, Florida; Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Kassem MW, Lake S, Roberts W, Salandy S, Loukas M. Cardiac veins, an anatomical review. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sławek-Szmyt S, Szmyt K, Żaba C, Grygier M, Lesiak M, Araszkiewicz A. Peculiarities in coronary sinus anatomy: implications for successful cannulation from an autoptic study. Europace 2021; 23:1787-1794. [PMID: 33864081 PMCID: PMC8576278 DOI: 10.1093/europace/euab108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/02/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The number of cardiovascular procedures using the coronary sinus (CS) as a gateway is constantly increasing. The present study aimed to define specific structures within CS, which could potentially complicate CS cannulation and to develop a new Thebesian valve (TV) classification system. Methods and results The study was performed on 560 consecutive unfixed cadaveric hearts during routine autopsy examination (1–3 days post-mortem). Basic CS dimensions were measured and the presence and dimensions of the TV and the Vieussens valve (VV) were assessed. Thebesian valves were classified according to their morphology into six main types: remnant fold, semilunar, fenestrated, chord, fused strands, and mixed shaped. The median age of hearts was 48 years (range 16–95 years), and 38.9% were female. Thebesian valve was present in 79.5%. The most common TV type was semilunar (54%) followed by fenestrated (8.2%), remnant fold (5.5%), fused strands (4.8%), chord (4.0%), and mixed shaped (3.0%). In 1.1% of hearts, TV totally covered the coronary sinus ostium (CSO). The VV was detected in 67.9%. Potentially occlusive VV was found in 1.1% hearts and in all of which it coexisted with obstructive TV. The median CSO area was 87.9 mm2 [interquartile range (IQR): 56.5–127.1 mm2] and median CS length was 38 mm (IQR: 29.5–45 mm). The CSO area and CS length correlated with each other and with the right atrium’s dimensions. Conclusion We identified six types of TVs, among which only 1.1% TVs caused total occlusion of CSO. The obstructive TV co-existed with potentially occlusive VV what might hinder CS cannulation.
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Affiliation(s)
- Sylwia Sławek-Szmyt
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848 Poznan, Poland
| | - Krzysztof Szmyt
- Department of General, Endocrine and Gastrointestinal Oncology Surgery, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznan, Poland
| | - Czesław Żaba
- Department of Forensic Medicine, Poznan University of Medical Sciences, Swiecicki Street 6, 60-789 Poznan, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848 Poznan, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848 Poznan, Poland
| | - Aleksander Araszkiewicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848 Poznan, Poland
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Vlachos K, Derval N, Pambrun T, Duchateau J, Martin CA, Bazoukis G, Frontera A, Takigawa M, Nakashima T, Efremidis M, Letsas KP, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Tixier R, Chauvel R, Welte N, Kitamura T, Cheniti G, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Ligament of Marshall ablation for persistent atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:782-791. [PMID: 33687764 DOI: 10.1111/pace.14208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
Beyond pulmonary vein isolation, the two main additional strategies: Cox-Maze procedure or targeting of electrical signatures (focal bursts, rotational activities, meandering wavelets), remain controversial. High-density mapping of these arrhythmias has demonstrated firstly that a patchy lesion set is highly proarrhythmogenic, favoring macro-re-entry through conduction slowing and providing pivots for localized re-entry. Secondly, discrete anatomical structures such as the Vein or Ligament of Marshall (VOM/LOM) and the coronary sinus (CS) have epicardial muscular bundles that are more frequently involved in re-entry than previously thought. The Marshall Bundle can be ablated at any point along its course from the mid-to-distal coronary sinus to the left atrial appendage. If necessary, the VOM may be directly ablated using ethanol infusion to eliminate PV contributions and produce conduction block across the mistral isthmus. Ethanol ablation of the VOM, supplemented with RF ablation, may be more effective in producing conduction block at the mitral isthmus than repeat RF ablation alone.
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Affiliation(s)
- Konstantinos Vlachos
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Josselin Duchateau
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France.,Cardiology Department, Royal Papworth Hospital, Cambridge, UK
| | - George Bazoukis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takashi Nakashima
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michael Efremidis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece.,Onassis Cardiac Surgery Centre, Athens, Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Clémentine André
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Philipp Krisai
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - F Daniel Ramirez
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Tsukasa Kamakura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takamitsu Takagi
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Romain Tixier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Remi Chauvel
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Welte
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michel Haïssaguerre
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Mélèze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
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Vernemmen I, Vera L, Van Steenkiste G, Deserranno B, Muylle S, Decloedt A, van Loon G. Right atrial-related structures in horses of interest during electrophysiological studies. Equine Vet J 2020; 53:1210-1217. [PMID: 33368591 DOI: 10.1111/evj.13413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Arrhythmias are common in horses, but catheter-based minimally invasive electrophysiological studies and therapeutic interventions have been poorly explored in equine medicine, partly due to the lack of detailed anatomical knowledge of the equine heart. OBJECTIVES To describe the dimensions and anatomical features of some electrophysiologically important landmarks of the right atrium in detail and assess their correlation with bodyweight and aortic diameter. STUDY DESIGN Ex vivo cadaveric study. METHODS Twenty-one hearts of Warmblood horses, subjected to euthanasia for noncardiovascular reasons, were examined post-mortem. The dimensions and anatomical features of the coronary sinus, the great cardiac vein and the oval fossa were recorded. Spearman's Rho correlation coefficients were calculated for correlations between the quantitative parameters and bodyweight and aortic diameter. RESULTS Median dimensions for coronary sinus, great cardiac vein and oval fossa were obtained. A Thebesian valve, partially covering the ostium of the coronary sinus, was present in 9 of the 21 hearts. A median of 6.5 (range 4-9) valves were present in the great cardiac vein. Several parameters, among which the dimensions of the oval fossa and the length of the great cardiac vein, were significantly positively correlated with bodyweight and aortic diameter. MAIN LIMITATIONS Measurements do not consider the dynamic changes during the cardiac cycle as measurements were performed ex vivo. All specimens were retrieved from Warmblood horses, therefore measurements might not apply to other breeds. CONCLUSIONS This study delivers a detailed description of important right atrial-related structures, necessary for the development of minimally invasive intracardiac procedures in horses. Adequate imaging techniques will have to be explored in order to guide these procedures.
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Affiliation(s)
- Ingrid Vernemmen
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lisse Vera
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bram Deserranno
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie Muylle
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Żabówka A, Hołda J, Strona M, Koziej M, Krawczyk‐Ożóg A, Jasińska KA, Kuniewicz M, Lelakowski J, Hołda MK. Morphology of the Vieussens valve and its imaging in cardiac multislice computed tomography. J Cardiovasc Electrophysiol 2019; 30:1325-1329. [DOI: 10.1111/jce.14018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/17/2019] [Accepted: 05/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Żabówka
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Marcin Strona
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Agata Krawczyk‐Ożóg
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Marcin Kuniewicz
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital in CracowJagiellonian University Medical College Cracow Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital in CracowJagiellonian University Medical College Cracow Poland
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
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11
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Mazur M, Żabówka A, Bolechała F, Kopacz P, Klimek‐Piotrowska W, Hołda MK. Variations and angulation of the coronary sinus tributaries: Implications for left ventricular pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:423-430. [DOI: 10.1111/pace.13618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Małgorzata Mazur
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Anna Żabówka
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Filip Bolechała
- Department of Forensic MedicineJagiellonian University Medical College Krakow Poland
| | - Paweł Kopacz
- Department of Forensic MedicineJagiellonian University Medical College Krakow Poland
| | - Wiesława Klimek‐Piotrowska
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
| | - Mateusz K. Hołda
- HEART‐Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Krakow Poland
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Hesselson AB, Duggal S, Rukavina M, Gallagher PL, Tomassoni GF. Coronary venous angioplasty to facilitate transvenous left ventricular lead placement: A single-center 13-year experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:383-388. [PMID: 29435997 DOI: 10.1111/pace.13303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/10/2018] [Accepted: 01/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Barriers to successful left ventricular lead placement within the coronary venous anatomy may include focal stenoses, thromboses, phrenic nerve stimulation, vessel tortuosity, small vessel caliber, nonexcitable tissue, and valve presence. A large series describing the utilization of coronary venous angioplasty (CVAP) for relief of these issues is absent in the literature. OBJECTIVE We report our experience on all patients treated with CVAP in a single-center 13-year experience. METHODS Forty-seven patients with CVAP (64% male, mean age 67 ± 12 years) were treated by five different implanting physicians for approved cardiac resynchronization therapy indications. The reason for CVAP was categorized by obstacle (focal occlusion, valve presence, small caliber vessel) and location. The number, type, and size of balloon used, inflation characteristics, complications, and success of lead deployment crossing the point of intervention were all tabulated. RESULTS Seventy-seven percent of patients (36/47) had successful CVAP. The most common reason for intervention was a focal occlusion (24/47; 51%), followed by valve presence (13/47; 28%), and small vessel caliber (10/47; 21%). Focal occlusions were most successfully managed with CVAP (23/24; 96%), followed by small vessel caliber (7/10; 70%) and valve presence (6/13; 46%). The reason for failure was most commonly due to failure to relieve the obstruction (5/11; 45%), thrombosis (3/11; 27.3%), dissection (2/11; 18.2%), and inability to pass the balloon through the occlusion (1/11; 9.0%). There were no significant complications developed from CVAP utilization. CONCLUSION In a large analysis, CVAP can be safely and successfully performed in the majority of instances required.
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Affiliation(s)
- Aaron B Hesselson
- Department of Cardiac Electrophysiology, Baptist Health Lexington, Lexington, KY, USA
| | - Sandeep Duggal
- Department of Cardiac Electrophysiology, Baptist Health Lexington, Lexington, KY, USA
| | - Michael Rukavina
- Department of Cardiac Electrophysiology, Baptist Health Lexington, Lexington, KY, USA
| | - Peter L Gallagher
- Department of Cardiac Electrophysiology, Baptist Health Lexington, Lexington, KY, USA
| | - Gery F Tomassoni
- Department of Cardiac Electrophysiology, Baptist Health Lexington, Lexington, KY, USA
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13
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Obstructive Thebesian valve: anatomical study and implications for invasive cardiologic procedures. Anat Sci Int 2013; 89:85-94. [DOI: 10.1007/s12565-013-0203-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
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Kim J, Kim JS. Incidental visualization of the septal vein of the left atrium. Korean Circ J 2013; 43:360-1. [PMID: 23755086 PMCID: PMC3675314 DOI: 10.4070/kcj.2013.43.5.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/05/2012] [Accepted: 12/10/2012] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jun Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong-Su Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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Spencer JH, Anderson SE, Iaizzo PA. Human coronary venous anatomy: implications for interventions. J Cardiovasc Transl Res 2013; 6:208-17. [PMID: 23307201 DOI: 10.1007/s12265-012-9443-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 12/19/2012] [Indexed: 11/29/2022]
Abstract
The coronary venous system is a highly variable network of veins that drain the deoxygenated blood from the myocardium. The system is made up of the greater cardiac system, which carries the majority of the deoxygenated blood to the right atrium, and the smaller cardiac system, which drains the blood directly into the heart chambers. The coronary veins are currently being used for several biomedical applications, including but not limited to cardiac resynchronization therapy, ablation therapy, defibrillation, perfusion therapy, and annuloplasty. Knowledge of the details of the coronary venous anatomy is essential for optimal development and delivery of treatments using this vasculature. This article is part of a JCTR special issue on Cardiac Anatomy.
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Affiliation(s)
- Julianne H Spencer
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA.
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16
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Shah SS, Teague SD, Lu JC, Dorfman AL, Kazerooni EA, Agarwal PP. Imaging of the coronary sinus: normal anatomy and congenital abnormalities. Radiographics 2012; 32:991-1008. [PMID: 22786990 DOI: 10.1148/rg.324105220] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Knowledge of the anatomy of the coronary sinus (CS) and cardiac venous drainage is important because of its relevance in electrophysiologic procedures and cardiac surgeries. Several procedures make use of the CS, such as left ventricular pacing, mapping and ablation of arrhythmias, retrograde cardioplegia, targeted drug delivery, and stem cell therapy. As a result, it is more important for physicians interpreting the results of computed tomographic (CT) examinations dedicated to the heart or including the heart to be able to identify normal variants and congenital anomalies and to understand their clinical importance. Abnormalities of the CS range from anatomic morphologic variations to hemodynamically significant anomalies such as an unroofed CS, anomalous pulmonary venous connection to the CS, and coronary artery-CS fistula. It can be important to identify some anatomic variations, even though they are clinically occult, to ensure appropriate preprocedural planning. Both CT and magnetic resonance imaging provide excellent noninvasive depiction of the anatomy and anomalies of the CS. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.324105220/-/DC1.
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Affiliation(s)
- Sanket S Shah
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, 1500 E Medical Center Dr, Cardiovascular Center, Room 5383, Ann Arbor, MI 48109-5868, USA.
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Cao M, Chang P, Garon B, Shinbane JS. Cardiac resynchronization therapy: double cannulation approach to coronary venous lead placement via a prominent thebesian valve. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:e70-3. [PMID: 22432962 DOI: 10.1111/j.1540-8159.2012.03362.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/07/2011] [Accepted: 12/03/2011] [Indexed: 01/30/2023]
Abstract
We report identification of a prominent Thebesian valve by cardiovascular computed tomography (CT) angiography impeding cannulation of the coronary sinus, with subsequent successful coronary venous lead placement with cannulation of the coronary sinus ostium via a transvenous femoral vein approach and subsequent cannulation of the ostium with the coronary venous lead with a left subclavian approach. A 57-year-old man with nonischemic dilated cardiomyopathy, New York Heart Association Class III heart failure, left bundle branch block, and an ejection fraction of 15%, underwent an attempted cardiac resynchronization therapy implantable cardiac defibrillator (ICD). As the coronary sinus ostium could not be cannulated, a dual chamber ICD was placed. The patient subsequently underwent cardiovascular CT angiography, which identified a prominent Thebesian valve at the coronary sinus ostium as the anatomic obstacle to cannulation. Reattempted transvenous cardiac resynchronization therapy was accomplished successfully with a double cannulation approach: cannulation of the coronary sinus ostium with a catheter via a transvenous femoral vein approach and subsequent cannulation with the coronary venous lead via a left subclavian approach. When a prominent Thebesian valve is identified as an obstacle to transvenous left ventricular lead placement, cannulation of the coronary sinus by an alternate venous approach may allow for a coronary venous route rather than necessitate an epicardial approach.
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Affiliation(s)
- Michael Cao
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, 1510 San Pablo Suite 322, Los Angeles, CA 90033, USA
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Saremi F, Muresian H, Sánchez-Quintana D. Coronary Veins: Comprehensive CT-Anatomic Classification and Review of Variants and Clinical Implications. Radiographics 2012; 32:E1-32. [DOI: 10.1148/rg.321115014] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Saremi F, Thonar B, Sarlaty T, Shmayevich I, Malik S, Smith CW, Krishnan S, Sánchez-Quintana D, Narula N. Posterior Interatrial Muscular Connection between the Coronary Sinus and Left Atrium: Anatomic and Functional Study of the Coronary Sinus with Multidetector CT. Radiology 2011; 260:671-9. [DOI: 10.1148/radiol.11102278] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Saremi F, Channual S, Sarlaty T, Tafti MA, Milliken JC, Narula J. Coronary Venous Aneurysm in Patients Without Cardiac Arrhythmia as Detected by MDCT. JACC Cardiovasc Imaging 2010; 3:257-65. [DOI: 10.1016/j.jcmg.2009.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 09/10/2009] [Accepted: 09/11/2009] [Indexed: 10/19/2022]
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Han S, Joung B, Scanavacca M, Sosa E, Chen PS, Hwang C. Electrophysiological characteristics of the Marshall bundle in humans. Heart Rhythm 2010; 7:786-93. [PMID: 20188860 DOI: 10.1016/j.hrthm.2010.02.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Marshall bundles (MBs) are the muscle bundles within the ligament of Marshall. OBJECTIVE This trial sought to the electrophysiological characteristics of the MB and the anatomical connections between MB and left atrium (LA) in patients with persistent atrial fibrillation (AF). METHODS We enrolled 72 patients (male:female 59:13, age 59.9 +/- 9.4 years) who underwent MB mapping and ablation for AF. MB mapping was done via an endocardial or epicardial approach during sinus rhythm and AF. RESULTS Recordings were successful in 64 of 72 patients (89%). A single connection was noted in 11 of 64 patients between the MB and the coronary sinus (CS) muscle sleeves. The MB recordings showed distinct MB potentials with a proximal-to-distal activation pattern during sinus rhythm. During AF, organized passive activations and dissociated slow MB ectopic activities were commonly observed in this type of connection. Double connections to both CS and LA around left pulmonary veins were noted in 23 of 64 patients (36%). After the ablation of the distal connection, MB recording showed typical double potentials as in single connection. Multiple connections were noted in 30 of 64 patients (47%). During sinus rhythm, the earliest activation was in the middle of the MB. The activation patterns were irregular and variable in each patient. During AF, rapid and fractionated complex activations were noted in all patients of this group. CONCLUSION We documented 3 different types of MB-LA connections. Rapid and fractionated activations were most commonly observed in the MB that had multiple LA connections.
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Affiliation(s)
- Seongwook Han
- Department of Medicine, Division of Cardiology, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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22
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Saremi F, Dang T. CT-guided cardiac electrophysiology. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Blendea D, Heist EK, Das S, Danik S, Barrett C, Mela T, Ruskin JN, Singh JP. Impact of tricuspid regurgitation and prior coronary bypass surgery on the geometry of the coronary sinus: a rotational coronary angiography study. J Cardiovasc Electrophysiol 2009; 21:436-40. [PMID: 19909387 DOI: 10.1111/j.1540-8167.2009.01639.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The coronary sinus (CS) is often distorted in patients with advanced cardiomyopathy, making CS cannulation difficult. The objective of this study was to examine the impact of the underlying cardiac pathology on the variability of the CS anatomy, using rotational coronary venous angiography (RCVA). METHODS AND RESULTS Seventy-nine patients undergoing RCVA for cardiac resynchronization therapy (CRT) were evaluated: age 63 +/- 15 years, 43% with prior coronary artery bypass grafting (CABG). Aspects of the CS anatomy which could impact cannulation were examined: the CS ostial angle, the posterior displacement of the CS away from the atrioventricular groove, a measure of CS curvature, and the presence of stenoses and aneurysmal dilatations. The CS ostial angle was variable (65-151 degrees, mean 119 +/- 19 degrees, <90 degrees in 8 patients) and decreased significantly (P = 0.0022) with increasing severity of tricuspid regurgitation (TR), reaching 94 +/- 18 degrees in patients with severe TR. The posterior displacement of the CS was significantly more accentuated in patients with prior CABG when compared with the patients without CABG (7.1 +/- 3.7 vs 4.5 +/- 2.8 mm; P = 0.0246). The decrease in luminal diameter at the CS-great cardiac vein (GCV) junction was 2.0 +/- 1.0 mm, being more pronounced in patients with prior CABG versus nonCABG (26 vs 20%; P = 0.042). Stenoses and aneurysmal dilatations of the CS-GCV were encountered in 4 (5%) and 6 (8%) of patients, respectively, all of them with prior CABG, representing 12% and 18% of the CABG group. CONCLUSION The CS anatomy in patients undergoing CRT is variable, and is impacted by the severity of the underlying TR and history of a prior CABG.
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Affiliation(s)
- Dan Blendea
- Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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Hasdemir C, Alp A, Can LH. Successful balloon dilatation of the valve of Vieussens for left ventricular lead placement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:828-9. [PMID: 19545352 DOI: 10.1111/j.1540-8159.2009.02376.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Successful balloon dilatation of an obstructive valve of Vieussens for left ventricular lead placement is described in a case with severe left ventricular systolic dysfunction.
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Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
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Mak GS, Hill AJ, Moisiuc F, Krishnan SC. Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures. Europace 2009; 11:1188-92. [PMID: 19587062 DOI: 10.1093/europace/eup179] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS The coronary sinus (CS) is a commonly cannulated structure in patients undergoing electrophysiology studies, catheter ablation of arrhythmias, implantation of resynchronization therapy devices and, more recently, percutaneous mitral valve repair. The advent of these procedures has led to a renewed interest in the anatomy of the coronary venous system including its various components. To improve our understanding of this structure, we studied the anatomy of the human CS, including the valve that guards its ostium, the Thebesian valve. METHODS AND RESULTS In 75 randomly selected autopsied human hearts, we measured the transverse and craniocaudal dimensions of the CS ostium and characterized the shape, composition, per cent coverage, and attachment points of the Thebesian valve when present. Of the 75 hearts examined, 54 had organic heart disease including atherosclerotic coronary artery disease, left ventricular hypertrophy, dilated cardiomyopathy, rheumatic heart disease, infective endocarditis, and non-rheumatic valvular heart disease. A wide variety of Thebesian valve morphologies were seen, ranging from the absence of any valve to those where the valve was completely occluding the CS ostium. A Thebesian valve was present in the majority of the hearts examined (55/75 hearts-73%). The average transverse dimension of the CS ostium in hearts with Thebesian valves (7.3+/-2.8 mm) was significantly shorter than those without Thebesian valves (9.4+/-2.9 mm, P=0.005). Similarly, the average craniocaudal dimension of the CS ostium in hearts with Thebesian valves (7.9+/-2.7 mm) was also significantly shorter than those without Thebesian valves (9.3+/-2.9 mm, P=0.045). CONCLUSION Our study shows that some form of Thebesian valve is present in the majority of hearts (>70%). Of these, a significant minority (16%) had a valve morphology (covering >75% of the ostium, a fibrous, fibromuscular, or muscular composition, and devoid of fenestrations) that makes them a 'potentially complicating' structure interfering with the cannulation of the CS.
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Affiliation(s)
- Gary S Mak
- Division of Cardiology, Department of Medicine, University of California at Irvine, 101 The City Drive South, Orange, CA 92868-4080, USA
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Cardiac Resynchronization Therapy Devices Guided by Imaging Technology. JACC Cardiovasc Imaging 2009; 2:226-30. [DOI: 10.1016/j.jcmg.2008.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 11/24/2008] [Indexed: 11/23/2022]
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Affiliation(s)
- Bernhard Strohmer
- Department of Cardiology, Salzburg Landeskliniken, Paracelsus Private Medical University, Salzburg, Austria.
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Venous valves within left ventricular coronary veins. J Interv Card Electrophysiol 2008; 23:95-9. [DOI: 10.1007/s10840-008-9282-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 05/20/2008] [Indexed: 10/21/2022]
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Saremi F, Krishnan S. Cardiac Conduction System: Anatomic Landmarks Relevant to Interventional Electrophysiologic Techniques Demonstrated with 64-Detector CT. Radiographics 2007; 27:1539-65; discussion 1566-7. [DOI: 10.1148/rg.276075003] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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Anderson SE, Hill AJ, Iaizzo PA. Venous valves: Unseen obstructions to coronary access. J Interv Card Electrophysiol 2007; 19:165-6. [PMID: 17909955 DOI: 10.1007/s10840-007-9161-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 08/21/2007] [Indexed: 11/28/2022]
Affiliation(s)
- Sara E Anderson
- Surgery, University of Minnesota, B172 Mayo, MMC 107, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Blendea D, Shah RV, Auricchio A, Nandigam V, Orencole M, Heist EK, Reddy VY, McPherson CA, Ruskin JN, Singh JP. Variability of coronary venous anatomy in patients undergoing cardiac resynchronization therapy: a high-speed rotational venography study. Heart Rhythm 2007; 4:1155-62. [PMID: 17765613 DOI: 10.1016/j.hrthm.2007.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Imaging the coronary venous (CV) tree to delineate the coronary sinus and its tributaries can facilitate electrophysiological procedures, such as cardiac resynchronization therapy (CRT) and catheter ablation. Venography also allows visualization of the left atrial (LA) veins, which may be a potential conduit for ablative or pacing strategies given their proximity to foci that can trigger atrial fibrillation. OBJECTIVE The aim of this study was to provide a detailed description of CV anatomy using rotational venography in patients undergoing CRT. METHODS Coronary sinus (CS) size and the presence, size, and angulation of its tributaries were determined from the analysis of rotational CV angiograms from 51 patients (age 68 +/- 11 years; n = 12 women) undergoing CRT. RESULTS The CS, posterior veins, and lateral veins were identified in 100%, 76%, and 91% of patients. Lateral veins were less prevalent in patients with a history of lateral myocardial infarction than in patients without such a history (33% vs. 96%; P = .014). The diameters of the CS and its tributaries were fairly variable (7.3-18.9 mm for CS, 1.3-10.5 mm for CS tributaries). The CS was larger in men than in women and in cases of ischemic than in cases of nonischemic cardiomyopathy (all P <.05). The vein of Marshall, the most constant LA vein, was identified in 37 patients; its diameter is 1.7 +/- 0.5 mm, and its takeoff angle is 154 degrees +/- 15 degrees , making the vein potentially accessible for cannulation. CONCLUSIONS Differences in CV anatomy that are related to either gender or coronary artery disease could have important practical implications during the left ventricular lead implantation. The anatomical features of the vein of Marshall make it a feasible potential conduit for epicardial LA pacing.
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Affiliation(s)
- Dan Blendea
- Cardiology Division, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Connecticut, USA
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Sá MI, de Roos A, Westenberg JJM, Kroft LJM. Imaging techniques in cardiac resynchronization therapy. Int J Cardiovasc Imaging 2007; 24:89-105. [PMID: 17503216 PMCID: PMC2121117 DOI: 10.1007/s10554-007-9229-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 04/19/2007] [Indexed: 11/25/2022]
Abstract
Cardiac resynchronization therapy is a high cost therapeutic option with proven efficacy on improving symptoms of ventricular failure and for reducing both hospitalization and mortality. However, a significant number of patients do not respond to cardiac resynchronization therapy that is due to various reasons. Identification of the optimal pacing site is crucial to obtain the best therapeutic result that necessitates careful patient selection. Currently, using echocardiography for mechanical dyssynchrony assessment performs patient selection. Multi-Detector-Row Computed Tomography (MDCT) and Magnetic Resonance Imaging (MRI) are new imaging techniques that may assist the cardiologist in patient selection. These new imaging techniques have the potential to improve the success rate of cardiac resynchronization therapy, due to pre-interventional evaluation of the venous coronary anatomy, to evaluation of the presence of scar tissue, and to improved evaluation of mechanical dyssynchrony. In conclusion, clinical issues associated with heart failure in potential candidates for cardiac resynchronization therapy, and the information regarding this therapy that can be provided by the imaging techniques echocardiography, MDCT, and MRI, are reviewed.
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Affiliation(s)
- Maria Isabel Sá
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jos J. M. Westenberg
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Lucia J. M. Kroft
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Gillis AM, Exner DV. I can see clearly now...but at what cost? Heart Rhythm 2006; 3:879-80. [PMID: 16876732 DOI: 10.1016/j.hrthm.2006.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Indexed: 11/23/2022]
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Karaca M, Bilge O, Dinckal MH, Ucerler H. The Anatomic Barriers in the Coronary Sinus: Implications for Clinical Procedures. J Interv Card Electrophysiol 2005; 14:89-94. [PMID: 16374555 DOI: 10.1007/s10840-005-4596-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Accepted: 08/25/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Coronary sinus (CS) catheterization is often used in cardiac resynchronization therapy. Failure to enter the CS is the most common reason for LV pacing lead implant failure. METHODS We evaluated the anatomic barriers, Thebesian and Vieussens valves, the CS and its tributaries in 52 adult human cadaver hearts. RESULTS The average diameter of CS ostiums was 9.47 mm. In 20 of the hearts heavier than 300 g, the average CS os diameter was 10.76 mm, whereas in the remaining hearts was 8.72 mm (p<0.005). The Thebesian valves were observed in 35(67%) of the hearts. In 39(75%) of the hearts Vieussens valves were observed and noted that 6(11%) of them were qualitatively well developed and 33(63%) diminutive. Twenty cases (38%) had 3 vein branches, 19(37%) had 4 branches, 6(11%) had 5 branches, 6(11%) had 2 branches and 1(2%) had 6 branches between great and middle cardiac veins. The anatomic barriers in coronary sinus i.e., Thebesian and Vieussens valves and their branchings were evaluated and found optimal, suboptimal and worst for catheterization in 33, 15 and 4 Thebesian valves; 40, 8, 4 Vieussens valves, respectively. The coronary sinus tributaries between great and middle cardiac veins were found to be optimal, suboptimal and worst for catheterization in 88, 60 and 38 veins, respectively. CONCLUSIONS Careful evaluation of anatomic barriers is important for treatment success. Thus, knowledge of these functional anatomic features and barriers allows for better utilization of the human coronary sinus for diagnostic and therapeutic purposes.
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Affiliation(s)
- Mustafa Karaca
- Cardiology Department, Sifa Hospital, and Faculty of Medicine, Department of Anatomy, Ege University, Izmir, Turkey
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Marchel M, Opolski G, Pietrasik A, Ciszek B, Zawadzki M, Pietrasik K. Direct visualization of the coronary sinus ostium and branches with the flexible endoscope. Heart Rhythm 2005; 2:1276; author reply 1276. [PMID: 16253924 DOI: 10.1016/j.hrthm.2005.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Indexed: 11/26/2022]
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Jongbloed MRM, Lamb HJ, Bax JJ, Schuijf JD, de Roos A, van der Wall EE, Schalij MJ. Noninvasive visualization of the cardiac venous system using multislice computed tomography. J Am Coll Cardiol 2005; 45:749-53. [PMID: 15734621 DOI: 10.1016/j.jacc.2004.11.035] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Accepted: 10/26/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We sought to evaluate the value of multislice computed tomography (MSCT) to depict the cardiac venous anatomy. BACKGROUND During cardiac resynchronisation therapy (CRT), left ventricular (LV) pacing is established by a pacemaker lead in a tributary of the coronary sinus (CS). Knowledge of the CS anatomy and variations may facilitate the implantation of LV leads. METHODS The MSCT scans of 38 patients (34 men; age 60 +/- 12 years) were studied. Anatomical variants were divided in three groups, dependent on the continuity of the cardiac venous system at the crux cordis. The CS ostium and distances between the main tributaries were measured. RESULTS The most frequently observed variant had a separate insertion of the CS and the small cardiac vein in the right atrium (24 patients [63%]). In 11 patients (29%), there was continuity of the anterior and posterior venous system at the crux cordis. In three patients (8%), the posterior interventricular vein (PIV) did not connect to the CS. The mean distance from the PIV to the posterior vein of the left ventricle (PVLV) was 42.4 +/- 18.1 mm, from the PVLV to the left marginal vein (LMV) 39.9 +/- 15.6 mm, and from the LMV to the anterior interventricular vein 45.4 +/- 15.3 mm. The diameter of the CS ostium was 12.6 +/- 3.6 mm in anteroposterior and 15.5 +/- 4.5 mm in the superoinferior direction (p < 0.01). CONCLUSIONS The anatomy of the CS and its tributaries can be evaluated using MSCT. As substantial variation in anatomy was observed, pre-implantation knowledge of the venous anatomy may help to decide whether transvenous LV lead placement for CRT is feasible.
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Abstract
Compared with the coronary arterial system, less attention has been paid to the coronary venous system. In the current era, there are therapeutic options for arrhythmias and for heart failure that use the coronary venous system to access target areas. We review the arrangement of the main cardiac veins to provide a morphologic background to interventionists. In general, the venous system is a useful conduit for delivery of percutaneous transcatheter treatment. But, variability in terms of valves, diameter, angulation, extent of muscular sleeves, proximity to other cardiac structures, and cross-over spatial relationship with branches of coronary arteries have implications for practitioners seeking to make use of the system.
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Affiliation(s)
- Siew Yen Ho
- Department of Paediatrics, National Heart & Lung Institute, Imperial College and Royal Brompton Hospital, London, UK.
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Zawadzki M, Pietrasik A, Pietrasik K, Marchel M, Ciszek B. Endoscopic study of the morphology of Vieussens valve. Clin Anat 2004; 17:318-21. [PMID: 15108337 DOI: 10.1002/ca.10229] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Vieussens valve (Vv) is the ostial valve of the great cardiac vein located near the beginning of the coronary sinus. Knowledge of its anatomy is important for several trans-sinus cardiologic procedures. The frequency of its presence is reported to vary from 65-87%. We documented the post mortem morphology of Vieussens valve in 50 unfixed, intact human coronary sinuses using endoscopy. We believe this is the first study of the anatomy of the coronary sinus and the adjacent venous ostia to employ this technique. Vieussens valve was observed in 78% of specimens. Special attention was given to the shape of the valve leaflets. Five morphological types of Vv were distinguished: single leaflet, flat (16%); single leaflet, concave (20%); double leaflet, flat (8%); double leaflet, concave (32%); and triple leaflet, concave (2%). We found post mortem endoscopy of the coronary sinus to be a good and reliable method of visualizing Vieussens valve.
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Affiliation(s)
- M Zawadzki
- Department of Anatomy, Center of Biostructure Research, The Medical University of Warsaw, Warsaw, Poland.
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