Posterior Interatrial Muscular Connection between the Coronary Sinus and Left Atrium: Anatomic and Functional Study of the Coronary Sinus with Multidetector CT

Abstract

To demonstrate coronary sinus-left atrium connections and evaluate coronary sinus function and anatomy in detail by using multidetector computed tomography (CT). In this institutional review board-approved retrospective study, the authors evaluated coronary CT angiograms obtained in 65 patients with normal sinus rhythm (normal group) and seven with atrial fibrillation at CT (atrial fibrillation group). Coronary sinus-right atrium muscle continuity was indirectly evaluated by measuring the length of the coronary sinus contraction during atrial systole. The length, number, and extent of coronary sinus-left atrium connections were recorded. The accuracy of CT was validated by comparing microscopic images of autopsied hearts with corresponding CT images. Comparisons were performed by using Student t tests for continuous variables. P ≤ .05 was considered indicative of a statistically significant difference. In the normal group, coronary sinus contraction was seen in 60 of the 65 patients (92%, mean length ± standard deviation, 25.7 mm ± 8.0). The coronary sinus narrowed 26% from middiastole to atrial systole (P < .0001). Coronary sinus-left atrium muscle connections were seen in 58 of the 65 patients (89%). A single connection was seen in 43 of the 65 patients (66%), with a mean length of 21.0 mm ± 14.0 within 12.0 mm ± 11.0 of the coronary sinus ostium. In 10 of the 43 patients (26%) with single connections, the connection extended to the coronary sinus ostium. In 10 of the 65 patients (15%), the entire coronary sinus was attached to the left atrial wall. Fifteen patients (23%) had two connections; distal connections measured 9 mm ± 2.4 in length within 2.2 mm ± 3.8 of the coronary sinus ostium, and proximal connections measured 15.4 mm ± 10.0 in length within 24.0 mm ± 8.0 of the coronary sinus ostium. In seven patients (11%), no coronary sinus-left atrium connection was seen; however, all showed a coronary sinus constriction during atrial systole, indicating that coronary sinus-right atrium muscle continuity is likely the primary cause for coronary sinus contractions. In the atrial fibrillation group, no coronary sinus contraction was seen. All images in the atrial fibrillation group showed a coronary sinus-left atrium connection, which was single in five patients and double in two. The area of the coronary sinus during diastole was larger in the atrial fibrillation group than in the normal group (114 mm(2) ± 37 vs 77 mm(2) ± 40, respectively; P = .02). CT can provide excellent information about coronary sinus function and coronary sinus-left atrium muscle connections.