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Pinto FF, Madeira MD, Pereira PA. Rare origin of the sinoatrial node artery: an anatomic report and a brief review of the literature. Anat Sci Int 2024:10.1007/s12565-024-00779-1. [PMID: 38789897 DOI: 10.1007/s12565-024-00779-1] [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: 07/18/2023] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Several studies reported anatomical variations in the sinoatrial node artery (SANa). Here, we report a rare variation in the origin of the SANa on a human adult male cadaver. During dissection, we identified the SANa originating from a large atrial branch of the right coronary artery (RCA). This branch originates at the level of the inferior border of the heart and courses upwards. The initial part of this vessel is tortuous, and then it follows a straight path parallel to the RCA along the anterior surface of the right atrium. After this part, the artery curves posteriorly and to the left until it reaches the lower border of the right auricle, where it closely approaches the RCA. Finally, the artery runs posteriorly and to the right to follow a course along the medial wall of the right auricle and right atrium to reach a location close to the region of the junction of the superior vena cava and right atrium, where it follows its path buried in the myocardium. After perforating the myocardium, this vessel gives rise to branches that are distributed to both atria in addition to the SANa. The SANa runs to the sinoatrial node in a precaval (anterior to the superior vena cava) course. We also tried to characterize the vessels radiologically. The knowledge of the anatomical variations of the SANa is of the utmost importance for cardiologists and heart surgeons to better understand cardiac disease and accurately plan and execute cardiac interventions and surgical procedures.
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Affiliation(s)
- Filipe F Pinto
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - M Dulce Madeira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Pedro A Pereira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal.
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Cardiogenic cerebral embolism due to sinus arrest associated with coronary intervention for the right coronary artery: A case report. J Cardiol Cases 2022; 25:210-212. [PMID: 35911069 PMCID: PMC9326011 DOI: 10.1016/j.jccase.2021.09.010] [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: 07/27/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022] Open
Abstract
Percutaneous coronary artery intervention (PCI) carries the risk of occlusion of the sinus node branch (SNB) which can lead to sinus arrest (SA). Generally, PCI-related SA recovers spontaneously, with a favorable clinical course. Herein, we describe a case of SNB occlusion after PCI for the right coronary artery which resulted in SA, subsequent left atrial appendage thrombus, and cardiogenic cerebral embolism (CE). Ultimately, the patient died due to cardiogenic CE. We report on the mechanism of intracardiac thrombus formation and discuss CE prevention strategies after PCI. Based on our experience, the possibility of adverse events due to PCI-induced SA must be considered, although PCI-induced SA is generally expected to resolve. <Learning objective: Percutaneous coronary artery intervention (PCI) carries the risk of occlusion of the side branches, including the sinus node branch (SNB). The occlusion of the SNB can lead to sinus arrest (SA). Generally, PCI-related SA recovers spontaneously. However, it should be noted that persistent SA can result in thrombus formation and cerebral embolism.>
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Gómez-Torres FA, Sebastian R, Ruíz-Sauri A. Morphometry and comparative histology of sinus and atrioventricular nodes in humans and pigs and their relevance in the prevention of nodal arrhythmias. Res Vet Sci 2019; 128:275-285. [PMID: 31869593 DOI: 10.1016/j.rvsc.2019.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
Abstract
The cardiac conduction system is a network structure that allows the initiation and fast propagation of electrical impulses that trigger the electrical depolarization of the myocardial tissue. The purpose of this work is to study the histological and morphometric characteristics of the different components of the sinus and atrioventricular nodes in humans and pigs and their relationship with supraventricular arrhythmias. In this study, we describe the morphometry of the sinus and atrioventricular nodes of 10 adult humans and 10 pig hearts. A computerized morphometric study has been carried out, where we determined the number of cells that compose the nodes as well as different parameters related to their shape and size. The sinus node in human and pig is a compact structure, whose shape is oblong. Their cells (nodal and transitional cells) are pale and located in the center and the periphery, respectively. The atrioventricular node has also a shape oblong. P cells are pale in both species, but in humans, they are smaller than cardiomyocytes. The T cells are small and pale in both species, identified by hematoxylin-eosin and desmin stains. We have observed through a morphometric profile that the structure of sinus and atrioventricular nodes of pigs and humans show few differences. Pigs can be used as models for hemodynamic applications and experimental studies that include atrial electrical conduction and, in this way, prevent the presentation of arrhythmias that can generate sudden deaths in humans and pigs.
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Affiliation(s)
- F A Gómez-Torres
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain; Department of Basic Sciences, Medicine School, Universidad Industrial de Santander, Cra 32 # 29-31, 68002 Bucaramanga, Colombia.
| | - R Sebastian
- Computational Multiscale Simulation Lab, Universitat de Valencia, Valencia 46100, Spain.
| | - A Ruíz-Sauri
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain; INCLIVA Biomedical Research Institute, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain.
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Vikse J, Henry BM, Roy J, Ramakrishnan PK, Hsieh WC, Walocha JA, Tomaszewski KA. Anatomical Variations in the Sinoatrial Nodal Artery: A Meta-Analysis and Clinical Considerations. PLoS One 2016; 11:e0148331. [PMID: 26849441 PMCID: PMC4743947 DOI: 10.1371/journal.pone.0148331] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The sinoatrial nodal artery (SANa) is a highly variable vessel which supplies blood to the sinoatrial node (SAN). Due to its variability and susceptibility to iatrogenic injury, our study aimed to assess the anatomy of the SANa and determine the prevalence of its anatomical variations. STUDY DESIGN An extensive search of major electronic databases was performed to identify all articles reporting anatomical data on the SANa. No lower date limit or language restrictions were applied. Anatomical data regarding the artery were extracted and pooled into a meta-analysis. RESULTS Sixty-six studies (n = 21455 hearts) were included in the meta-analysis. The SANa usually arose as a single vessel with a pooled prevalence of 95.5% (95%CI:93.6-96.9). Duplication and triplication of the artery were also observed with pooled prevalence of 4.3% (95%CI:2.8-6.0) and 0.3% (95%CI:0-0.7), respectively. The most common origin of the SANa was from the right coronary artery (RCA), found in 68.0% (95%CI:55.6-68.9) of cases, followed by origin from the left circumflex artery, and origin from the left coronary artery with pooled prevalence of 22.1% (95%CI:15.0-26.2) and 2.7 (95%CI:0.7-5.2), respectively. A retrocaval course of the SANa was the most common course of the artery with a pooled prevalence of 47.1% (95%CI:36.0-55.5). The pooled prevalence of an S-shaped SANa was 7.6% (95%CI:2.9-14.1). CONCLUSIONS The SANa is most commonly reported as a single vessel, originating from the RCA, and taking a retrocaval course to reach the SAN. Knowledge of high risk anatomical variants of the SANa, such as an S-shaped artery, must be taken into account by surgeons to prevent iatrogenic injuries. Specifically, interventional or cardiosurgical procedures, such as the Cox maze procedure for atrial fibrillation, open heart surgeries through the right atrium or intraoperative cross-clamping or dissection procedures during mitral valve surgery using the septal approach can all potentiate the risk for injury in the setting of high-risk morphological variants of the SANa.
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Affiliation(s)
- Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Joyeeta Roy
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Piravin Kumar Ramakrishnan
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Wan Chin Hsieh
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jerzy A. Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof A. Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Ciulla MM, Astuti M, Carugo S. The atherosclerosis of the sinus node artery is associated with an increased history of supra-ventricular arrhythmias: a retrospective study on 541 standard coronary angiograms. PeerJ 2015; 3:e1156. [PMID: 26336639 PMCID: PMC4556151 DOI: 10.7717/peerj.1156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background. The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA). Accordingly we aimed this retrospective study to: (1) evaluate the suitability of the standard coronary angiography to study the SNA and (2) determine if the percentage of subjects with a positive retrospective history of supra-ventricular arrhythmias (SVA) differs in patients with normal and diseased SNA ascertained at the time of coronary angiography. Methods and Results. Out of the 541 coronary angiograms reviewed the SNA was visible for its entire course in 486 cases (89.8%). It was found to arise from the right side of the coronary circulation in 266 cases (54.7%) slightly more often than from the left, 219 cases (45.1%). One patient had 2 distinct SNA arising from either side of the coronary circulation. For the second objective, we studied the 333 patients with: (a) coronary artery disease (CAD), (b) properly evaluable SNA and (c) complete clinical history available. In 51 (15.3%) a SNA disease was found, 41.2% of them had a positive SVA history, mainly atrial fibrillation (AF), whereas only 7.4% of patients with a positive history of SVA could be found in the non-SNA diseased. This difference was statistically significant (P < 0.001). Conclusions. (1) The evaluation of the SNA is feasible in clinical practice during a standard coronary angiography; (2) this may be relevant since angiographically detectable SNA disease was significantly associated with a positive history of SVA.
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Affiliation(s)
- Michele M Ciulla
- Laboratory of Clinical Informatics and Cardiovascular Imaging , Milan , Italy ; Department of Clinical Sciences and Community Health, University of Milan , Milan , Italy
| | - Matteo Astuti
- Department of Clinical Sciences and Community Health, University of Milan , Milan , Italy ; Cardiovascular Diseases Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Stefano Carugo
- Department of Health Sciences, University of Milan , Milan , Italy
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Shimotakahara R, Shimada K, Kodama K. Anatomical study on the sinuatrial nodal branch in the human coronary artery. Anat Sci Int 2013; 89:79-84. [DOI: 10.1007/s12565-013-0202-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/02/2013] [Indexed: 11/30/2022]
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The most vulnerable large atrial arteries during surgery and radiofrequency ablation of the pulmonary veins. Int J Cardiol 2012; 160:148-9. [PMID: 22704874 DOI: 10.1016/j.ijcard.2012.05.075] [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: 05/11/2012] [Accepted: 05/27/2012] [Indexed: 11/22/2022]
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Song YS, Lee W, Park EA, Chung JW, Park JH. Anatomy of the sinoatrial nodal branch in Korean population: imaging with MDCT. Korean J Radiol 2012; 13:572-8. [PMID: 22977324 PMCID: PMC3435854 DOI: 10.3348/kjr.2012.13.5.572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 03/26/2012] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate, on a retrospective basis, the anatomic characteristics of the arterial supply to the sinoatrial node (SAN) in the Korean population using an ECG-gated multi-detector CT (MDCT). Materials and Methods The electrocardiographic-gated MDCTs of 500 patients (258 men and 242 women; age range, 17-83 years; mean age, 58.6 ± 12.04 years) were analyzed retrospectively. In each case, the SAN artery (arteries) was named according to a special nomenclature with regard to origin, course, and termination. Results A total of 516 SAN arteries were visualized in 496 patients. The SAN was supplied by a single artery in 476 (96.4%) cases and by 2 arteries in 18 (3.6%) cases. The SAN originated from the right coronary artery in 265 (53.4%) cases and from the left circumflex in 213 (43%) cases. Conclusion This study can provide basic data on variations of the SAN artery in the Korean population.
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Affiliation(s)
- Yong Sub Song
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
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Ballesteros LE, Ramírez LM, Forero PL. Características morfológicas y posibles implicaciones clínicas de las arterias nodales. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Arterial supply of the sinoatrial node: a CT coronary angiographic study. Int J Cardiovasc Imaging 2010; 27:619-27. [PMID: 20857199 DOI: 10.1007/s10554-010-9705-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/10/2010] [Indexed: 10/19/2022]
Abstract
We aimed to investigate the variances in especially the origin, course and termination of the sinoatrial node (SAN) artery in this study, using coronary CT angiography. The coronary CT angiography images of 251 patients (190 men and 61 women; age range, 20-82 years; mean age, 54.4 ± 13.6 years) were retrospectively analyzed. The SAN artery (arteries) in each case was named according to a special nomenclature with regard to their origin, course and termination. The sinoatrial node was being vascularized by a single artery in 241 (96%) cases and by two arteries in 10 (4%) cases. It was arising from RCA in 139 (55.4%) cases, from LCX in 99 (39.4%) cases, from the aorta in 2 (0.8%) cases, and from the bronchial artery in 1 (0.4%) case. The mean diameter of the SAN arteries was 2.3 mm. The mean distance between the origin of the SAN artery from RCA and the RCA ostium was 16.2 mm, from LCX and the origin of LCX was 19.3 mm. Frequency of the atrial branch was 35.9%. S-shaped SAN artery is determined in 51 (20.3%) cases. Coronary CT angiography is considerably effective in depicting the various vascularization types of SAN.
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Zhang LJ, Wang YZ, Huang W, Chen P, Zhou CS, Lu GM. Anatomical investigation of the sinus node artery using dual-source computed tomography. Circ J 2008; 72:1615-20. [PMID: 18728333 DOI: 10.1253/circj.cj-08-0149] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few investigators have studied the anatomy of the sinus node artery (SNA) using noninvasive imaging modalities, so the objective of this study was to visualize the in-vivo 3-dimensional anatomical relations of the SNA using dual-source computed tomography (DSCT). METHODS AND RESULTS In the 101 patients included in this study, the visualization rate, anatomical type and diameter of the SNA, the distance between the orifice and coronary artery, and the terminal type of SNA were recorded. The visualization rate was 95.2% (96/101). Of 96 patients, 106 SNAs were detected among which 51 (48.1%, 51/106) originated from the right coronary artery, 52 (49.1%, 52/106) from the left circumflex artery, and 3 (2.7%, 3/106) from other branches. There were 3 types of SNA: right (n = 52), left (n = 45), and posterior (n = 9). The distance between the orifice of the right SNA and the right coronary sinus was 14.2+/-15.2 mm, for the left SNA it was 5.5+/-3.5 mm, and for the posterior SNA, 33.7+/-12.8 mm. The average diameter was 1.27+/-0.29 mm. The SNA approached the nodal tissue by 1 of 3 routes: retrocaval (51.5%), precaval (25.2%), or pericaval (22.3%). CONCLUSION The SNA can be visualized in vivo using DSCT, which is important for preoperative knowledge of its origin, course, termination, and anatomical type.
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Affiliation(s)
- Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, China
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Abstract
OBJECTIVE The purpose of this study was to use 64-MDCT to investigate the anatomic characteristics of the S-shaped variant of the sinoatrial node (SAN) artery and to describe the clinical implications of the findings in ablative procedures involving the left atrium. MATERIALS AND METHODS Coronary CT angiograms of 250 patients (152 men, 98 women; mean age, 60 +/- 12 [SD] years) were retrospectively analyzed for identification of the origin, number, anatomic course, mode of termination, and S-shaped variant of the SAN artery. RESULTS At least one SAN artery was detected in 244 patients. The S-shaped variant was seen in 35 (14.3%) of these patients. Thirty-four of the variants (30.6% of all left SAN arteries) arose from the proximal to middle portion of the left circumflex artery (mean distance between the ostium of the left circumflex artery and the origin of S-shaped variant, 28.7 +/- 13.1 mm). The other variant (0.7% of all right SAN arteries) originated from the distal right coronary artery. The S-shaped variant was the only artery supplying the SAN in 28 (11.4%) of the patients. In patients with two arteries supplying the SAN, the right SAN artery and the S-shaped variant of the left SAN artery were seen together in seven patients. The S-shaped SAN artery (mean distance from atrial wall, 2.43 +/- 0.992 mm) had a predictable proximal course, lying in the posterior aspect in a groove between the orifices of the left superior pulmonary vein and the left atrial appendage close to the left atrial wall. The terminal segment of the artery approached the nodal tissue posterior to the superior vena cava in 22 patients, anterior to the vena cava in 10 patients, and through branches surrounding the vena cava in two patients. CONCLUSION The S-shaped variation of the SAN artery is common and has a characteristic anatomic course. MDCT can be used to plan surgical and catheter-based left atrial interventions in which this artery is at risk of injury.
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