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Lisaherring - One of the best experts on this subject based on the ideXlab platform.
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Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways
Circulation, 2002Co-Authors: Yingxiansun, Mauricioarruda, Kenichirootomo, Karenbeckman, Hiroshinakagawa, Jamescalame, Sunnypo, Peterspector, Daniellustgarten, LisaherringAbstract:Background— The coronary sinus (CS) has a myocardial coat (CSMC) with extensive connections to the left and right atria. We postulated that some posteroseptal and left posterior accessory pathways (CSAPs) result from connections between a cuff of CSMC extending along the middle Cardiac Vein (MCV) or posterior coronary Vein (PCV) and the ventricle. The purpose of the present study was to use CS angiography and mapping to define and determine the incidence of CSAPs and determine the relationship to CS anatomy. Methods and Results— CSAP was defined by accessory pathway (AP) potential or earliest activation in the MCV or PCV and late activation at anular endocardial sites. A CSAP was identified in 171 of 480 patients undergoing ablation of a posteroseptal or left posterior AP. CS angiography revealed a CS diverticulum in 36 (21%) and fusiform or bulbous enlargement of the Small Cardiac Vein, MCV, or CS in 15 (9%) patients. The remaining 120 (70%) patients had an angiographically normal CS. A CSMC extension po...
Lisa Herring - One of the best experts on this subject based on the ideXlab platform.
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Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways: Incidence and Electrophysiological Identification
Circulation, 2002Co-Authors: Yingxian Sun, Mauricio Arruda, Kenichiro Otomo, Karen J. Beckman, Hiroshi Nakagawa, James Calame, Peter S. Spector, Daniel L. Lustgarten, Lisa HerringAbstract:The coronary sinus (CS) has a myocardial coat (CSMC) with extensive connections to the left and right atria. We postulated that some posteroseptal and left posterior accessory pathways (CSAPs) result from connections between a cuff of CSMC extending along the middle Cardiac Vein (MCV) or posterior coronary Vein (PCV) and the ventricle. The purpose of the present study was to use CS angiography and mapping to define and determine the incidence of CSAPs and determine the relationship to CS anatomy. CSAP was defined by accessory pathway (AP) potential or earliest activation in the MCV or PCV and late activation at anular endocardial sites. A CSAP was identified in 171 of 480 patients undergoing ablation of a posteroseptal or left posterior AP. CS angiography revealed a CS diverticulum in 36 (21%) and fusiform or bulbous enlargement of the Small Cardiac Vein, MCV, or CS in 15 (9%) patients. The remaining 120 (70%) patients had an angiographically normal CS. A CSMC extension potential (CSE), like an AP potential, was recorded in the MCV in 98 (82%), in the PCV in 13 (11%), in both the MCV and PCV in 6 (5%), and in the CS in 3 (2%) of 120 patients. CSMC potentials were recorded between the timing of atrial and CSE potentials. CSAPs result from a connection between a CSMC extension (along the MCV or PCV) and the ventricle. The CS is angiographically normal in most patients.
Yingxiansun - One of the best experts on this subject based on the ideXlab platform.
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Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways
Circulation, 2002Co-Authors: Yingxiansun, Mauricioarruda, Kenichirootomo, Karenbeckman, Hiroshinakagawa, Jamescalame, Sunnypo, Peterspector, Daniellustgarten, LisaherringAbstract:Background— The coronary sinus (CS) has a myocardial coat (CSMC) with extensive connections to the left and right atria. We postulated that some posteroseptal and left posterior accessory pathways (CSAPs) result from connections between a cuff of CSMC extending along the middle Cardiac Vein (MCV) or posterior coronary Vein (PCV) and the ventricle. The purpose of the present study was to use CS angiography and mapping to define and determine the incidence of CSAPs and determine the relationship to CS anatomy. Methods and Results— CSAP was defined by accessory pathway (AP) potential or earliest activation in the MCV or PCV and late activation at anular endocardial sites. A CSAP was identified in 171 of 480 patients undergoing ablation of a posteroseptal or left posterior AP. CS angiography revealed a CS diverticulum in 36 (21%) and fusiform or bulbous enlargement of the Small Cardiac Vein, MCV, or CS in 15 (9%) patients. The remaining 120 (70%) patients had an angiographically normal CS. A CSMC extension po...
Yingxian Sun - One of the best experts on this subject based on the ideXlab platform.
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Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways: Incidence and Electrophysiological Identification
Circulation, 2002Co-Authors: Yingxian Sun, Mauricio Arruda, Kenichiro Otomo, Karen J. Beckman, Hiroshi Nakagawa, James Calame, Peter S. Spector, Daniel L. Lustgarten, Lisa HerringAbstract:The coronary sinus (CS) has a myocardial coat (CSMC) with extensive connections to the left and right atria. We postulated that some posteroseptal and left posterior accessory pathways (CSAPs) result from connections between a cuff of CSMC extending along the middle Cardiac Vein (MCV) or posterior coronary Vein (PCV) and the ventricle. The purpose of the present study was to use CS angiography and mapping to define and determine the incidence of CSAPs and determine the relationship to CS anatomy. CSAP was defined by accessory pathway (AP) potential or earliest activation in the MCV or PCV and late activation at anular endocardial sites. A CSAP was identified in 171 of 480 patients undergoing ablation of a posteroseptal or left posterior AP. CS angiography revealed a CS diverticulum in 36 (21%) and fusiform or bulbous enlargement of the Small Cardiac Vein, MCV, or CS in 15 (9%) patients. The remaining 120 (70%) patients had an angiographically normal CS. A CSMC extension potential (CSE), like an AP potential, was recorded in the MCV in 98 (82%), in the PCV in 13 (11%), in both the MCV and PCV in 6 (5%), and in the CS in 3 (2%) of 120 patients. CSMC potentials were recorded between the timing of atrial and CSE potentials. CSAPs result from a connection between a CSMC extension (along the MCV or PCV) and the ventricle. The CS is angiographically normal in most patients.
M Von Lüdinghausen - One of the best experts on this subject based on the ideXlab platform.
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The venous drainage of the human myocardium.
Advances in anatomy embryology and cell biology, 2003Co-Authors: M Von LüdinghausenAbstract:New cardiological techniques such as coronary sinus catheterization and selective catheterization of the Cardiac Veins permit the opening of new experimental and clinical fields, for instance in venous angiography and the reverse nourishment of myocardium which is endangered by ischemia,and also in the electrophysiological study of the components of the conduction system. New approaches in heart surgery, such as the removal of accessory pathways of the conduction system (as in WPW syndrome), necessitate the realization of the topographical relationships of the vessels in the various sections of the coronary sulci in a different way. The objective of this work is, therefore, to present comprehensive and almost new macro- and microanatomical data about the venous drainage of the myocardium via the coronary sinus and its related and unrelated (non-coronary) Cardiac Veins. Examination of meticulously dissected heart specimens (of individuals who had achieved old or extreme old age at the time of their death in Germany: n=250) as well as corrosion casts of adult Cardiac vessels (of individuals of all ages, n=25) formed the basis for the exact description and documentation of the occurrence, frequency, origin, and courses of both the normal and anomalously developed human coronary sinus and Cardiac Veins. A wide range of morphological and experimental references was consulted in order to enable thorough discussion of the anatomical findings in the light of modern cardiological diagnostics and treatment. The anatomical and clinical nomenclature is presented and there is a brief comment on modern diagnostic techniques and their applications where the Cardiac Veins are concerned. The two principal and one compound Cardiac venous system are defined and discussed with reference to the existence of both the normal and anomalous coronary sinus and Cardiac Vein. 1. The greater (major) Cardiac venous system (2) The Smaller (minor) Cardiac venous system (3)The compound Cardiac venous system. The microanatomy of the various proper Cardiac Veins is not very well explained and illustrated in old or new literature; therefore, special attention is paid in the present study to the detailed microanatomy of the Cardiac venous drainage. This includes the topograpy and structural and surface anatomy of the coronary sinus (position, length and shape, diameters, area of cross-section, circumference and volume, curvature, elevation, ostial angle, enlargement, duplication, absence), and the exact enternal and internal morphological landmarks of the coronary sinus with reference to its myocardial cover, isolated myocardial belts, and "free" myocardial cords which connect the atrial and ventricular myocardium, and the atrial ostium of the coronary sinus. It is established that the frequency, distribution pattern, courses and mode of opening of the major ventricular and atrial Cardiac Veins and the occurrence, morphology, and efficiency of the ostial valves of the coronary sinus and its tributaries all influence the success of any selective catheter implantation and venous reperfusion technique to a great degree. There are many peculiarities of the Cardiac Veins which are worthy of consideration, for instance intramyocardial and aberrant courses of the anterior interventricular Vein, the oblique Vein of the left atrium, the posterior interventricular Vein, the Small Cardiac Vein, the posterior Vein of the left ventricle, the left and right marginal Veins, and the anterior Cardiac Veins. Various forms and courses of the intramural venous tunnel, sinus or channel of the right atrium were found and illustrated, and discussed in terms of developmental and comparative anatomy. This review incorporates a great variety of clinically significant, new morphological findings with regard to the coronary sinus and the Cardiac venous system. The many anatomical peculiarities and hindrances to the catheterization of the coronary sinus and the reperfusion of (even selected) Cardiac Veins are documented and evaluated; the various problems which may arise in venous reperfusion due to the presence of anatomical anomalies of the coronary sinus, Cardiac Veins, and ostial valves (of greater or lesser efficiency) are addressed. The presentation narrows a gap in the rather incomplete knowledge of the venous drainage of the human myocardium.
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The Venous Drainage of the Human Myocardium
2002Co-Authors: M Von LüdinghausenAbstract:1 Introduction.- 1.1 Goal of CS Catheterization.- 1.2 Objective of the Study.- 2 The Organization of the Cardiac Venous Systems.- 2.1 The Greater (Major) Cardiac Venous System.- 2.2 The Smaller (Minor) Cardiac Venous System.- 2.3 The Compound Form of Cardiac Venous Vessels: Intramural Sinuses and Tunnels.- 3 Nomenclatur.- 3.1 English and Latin Versions.- 3.2 Abbreviations.- 3.3 Commonly Used Unofficial or Alternative Terms and Synonyms for the Cardiac Veins.- 4 Microanatomy of the Coronary Sinus.- 4.1 Anatomy, Position, and Topography.- 4.2 Surface Anatomy.- 4.3 Length and Shape.- 4.4 Diameter, Area of Cross-Section, Circumference, and Volume.- 4.5 Elevation, Curvature, and Ostial Angle.- 4.6 The Ostial Valve.- 4.7 Enlargement of the CS, Aneurysm of the CS.- 4.8 Enlargement of the CS Associated with Persistent Left Superior Vena Cava.- 4.9 Enlargement of the CS Associated with Ostial Occlusion.- 4.10 Duplication of the CS (Sinus Coronarius 'Duplex').- 4.11 Absence of the CS.- 5 The Myocardial Cover of the Coronary Sinus and Related Veins.- 5.1 The Myocardial Cover of the CS.- 5.1.1 Peculiarity.- 5.2 The Left (Distal) Boundary of the Myocardial Coat of the CS and the Myocardial Cuff of the Terminal GCV.- 5.2.1 The Myocardial Coat of the CS.- 5.2.2 The Myocardial Cuff of the Terminal GCV.- 5.3 The Right (Proximal) Boundary of the Myocardial Coat of the CS.- 5.4 Isolated Myocardial Belts in the Terminal Portions of Other Cardiac Veins.- 5.5 'Free' Myocardial Cords in the Left Posterior Coronary Sulcus.- 5.6 The Proximal Origin of the CS and Its Landmarks.- 5.6.1 The OV Is the Only Exact Peripheral Landmark for the Origin of the CS.- 5.6.2 Clinical Significance of Accessory Myocardial Cuffs, Belts, and Cords.- 6 The Anatomy of the Veins Draining the Myocardium of Both Ventricles.- 6.1 The Ventricular Cardiac Veins in General.- 6.1.1 The Apical Venous Network.- 6.1.2 Venous Valves.- 6.1.3 Left and Right V entricular Veins.- 6.1.4 Left and Right Atrial Veins.- 6.2 Frequency and Distribution Pattern of the Tributaries of the CS.- 6.3 The Great Cardiac Vein and the Anterior Interventricular Vein.- 6.4 S-Shaped (Sigmoid) Course of the Great Cardiac Vein.- 6.5 Intramyocardial Course of, or Myocardial Bridge Over, the Subepicardial Veins.- 6.6 Aberrant Course of the Anterior Interventricular Part of the Great Cardiac Vein.- 6.7 The Ostial (Terminal) Valve of the Great Cardiac Vein.- 6.8 The Oblique Vein of the Left Atrium.- 6.9 The Posterior Interventricular Vein.- 6.9.1 Ostial Valves.- 6.10 The Septal Veins.- 6.10.1 Anterior and Posterior Territories of the Interventricular Septum.- 6.10.2 Left Superior Septal Vein.- 6.10.3 Anterior Septal Veins.- 6.10.4 Right Superior Septal Vein.- 6.10.5 Venous Valves (Astklappen).- 6.10.6 Venous Drainage of the AV Junction.- 6.11 The Posterior Vein(s) of the Left Ventricle.- 6.12 The Small Cardiac Vein.- 6.13 The Left Marginal Vein.- 6.14 The Right Marginal Vein.- 6.15 The Anterior Cardiac Veins.- 6.16 The Venous Drainage of the Papillary Muscles.- 6.17 The Ostial Valves of Cardiac Veins.- 6.18 The Relationships Between Cardiac Veins and Coronary Arteries.- 6.19 The Veins of the Visceral Serosa.- 6.20 Venous Anastomoses.- 6.21 The Veins of the Vasa Vasorum of the Coronary Arteries, Aorta Ascendens and Pulmonary Trunk.- 7 The Anatomy of Veins Draining the Myocardium of Both Atria.- 7.1 The Veins of the Left Atrium.- 7.1.1 Posterolateral Veins of the LA.- 7.1.2 Posterosuperior Veins of the LA.- 7.1.3 Anteroseptal and Posteroseptal Veins of the LA.- 7.1.4 Ostial Valves of the Anteroseptal and Posteroseptal Veins of the LA.- 7.1.5 Intramural Sinuses of the Atrial Walls.- 7.1.6 ExtraCardiac Intercommunications.- 7.2 The Veins of the Right Atrium.- 7.2.1 Small Right Atrial Veins.- 7.2.2 Venous Drainage of the SA Node.- 7.2.3 Venous Drainage of the AV Node and Bundle Area.- 7.2.4 Venous Tunnel or Sinus of the Right Atrium.- 7.2.5 The Ostia of the VTRA.- 7.2.6 Topographical Relationship of the VTRA.- 7.2.7 Explanation for the Existence of the VTRA.- 8 The Significance of the Coronary Sinus and Cardiac Veins in Cardiology.- 8.1 The Anatomical Basis for Reperfusion of the CS and Selected Cardiac Veins and Imaging of the Coronary Venous Drainage System Using CT.- 8.1.1 Purpose of Reperfusion Technique.- 8.1.2 Basis of CS Catheterization.- 8.1.3 Failure and Limitation ofCS Catheterization.- 8.1.4 Computed Tomography.- 8.1.5 Coronary Venography.- 8.1.6 The Significance of Ostial Valves.- 8.1.7 The Significance of the Smallest Cardiac.- 8.1.8 Concept of the Hydraulic System of the Intramural and Subendocardial Sinuses in the Cardiac Walls and in the Heart Chambers.- 8.2 Anatomical Peculiarities Supporting Venous Reperfusion via the CS.- 8.3 Anatomical Hindrances to Catheterization of the CS and of Cardiac Veins.- 8.3.1 The Ostial Valve of the IVC.- 8.3.2 Persistent Left SVC.- 8.3.3 Aneurysm of the RA, Aneurysm of the CS.- 8.3.4 Rigid Ostial Valves of the CS and GCV.- 8.3.5 Congenital Occlusion of the Atrial Ostium of the CS.- 8.3.6 Openings of the PIV and PVLV Near to the Atrial Ostium of the CS.- 8.3.7 The ACVs and the RMV Empty Directly into the RA.- 8.3.8 Opening of the PIV Directly into the RA.- 8.3.9 The Anterior Interventricular Artery Crosses over the GCV.- 8.3.10 Intramyocardial Course of the AIV.- 8.3.11 Uni- or Bicuspid Valves of the Anterior and Posterior Septal Veins.- 8.3.12 Ectopic Origin and Aberrant Course of the AIV.- 9 The Cardiac Venous System Seen Three-Dimensionally: An Arrangement of Veins Which Favors Reperfusion Efficacy.- 9.1 The Efficiency of Ostial Valves.- 9.2 Prospect.- 10 Summary.- References.