Coronary Sinus Ostium Research Articles

Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method.

BackgroundThe anatomical tachycardia circuit of sinoatrial node reentrant tachycardia (SANRT) has not been well clarified. This study aimed to elucidate the tachycardia circuit of SANRT.Methods and ResultsExit and entrance of the intranodal sinoatrial node conduction (I‐SANC) of the reentry circuit were identified in 15 SANRT patients. After identifying the earliest atrial activation site (EAAS) during the tachycardia (EAAS‐SANRT), rapid atrial pacing was delivered from multiple atrial sites to identify the entrainment pacing site where manifest entrainment and orthodromic capture of the EAAS‐SANRT were demonstrated. Radiofrequency energy was then delivered starting at a site 2 cm proximal to the EAAS‐SANRT in the direction of the entrainment pacing site and gradually advanced toward the EAAS‐SANRT until tachycardia termination to localize the I‐SANC entrance. The EAAS‐SANRT was orthodromically captured by pacing delivered from the distal coronary sinus (n=7), high posteroseptal right atrium (n=2), low posteroseptal right atrium (n=2), low anterolateral right atrium (n=2), or coronary sinus ostium (n=2). Radiofrequency energy delivery to the entrance of the I‐SANC, 10.4±2.8 mm away from the EAAS‐SANRT, terminated tachycardia immediately after onset of energy delivery (3.4±2.3 seconds). The successful ablation site was located further from the EAAS during sinus rhythm (EAAS‐sinus) than the EAAS‐SANRT (12.8±4.5 versus 7.2±3.1 mm; P<0.0001).ConclusionsThe reentry circuit of SANRT was composed of the entrance and exit of the I‐SANC being located at distinctly different anatomical sites. SANRT was eliminated by radiofrequency energy delivered to the I‐SANC entrance, which was further from the EAAS‐sinus than I‐SANC exit.

Presence of the annular ridge and location of the coronary sinus ostium as morphological features ofthe right atrium and interatrial septum in healthy common marmosets (Callithrix jacchus).

To effectively use a common marmoset (Callithrix jacchus) as an experimental animal species, it is critical to establish a normal characteristics and morphology of the organs of the common marmoset. Although gross morphology of the common marmoset heart is reportedly the same as that of humans, little information is available regarding detailed morphology of the right atrium and the interatrial septum. Heart specimens were collected from three male and 10 female marmosets aged 9 to 65 months to determine the morphological features of the right atrium and the interatrial septum. Ten specimens were evaluated morphologically with a stereoscopic microscope in accordance with preparation and investigation methods designed to facilitate evaluation. Three specimens were histologically evaluated after being stained with hematoxylin-eosin, Elastica van Gieson and periodic acid Schiff. An annular ridge that is not present in the human heart was present in the right atrium and the interatrial septum of the common marmoset hearts. Tissue structure of the annular ridge was similar to atrial myocardial fibers. Furthermore, location of the coronary sinus ostium was different to that in humans. Present findings were used to create a schematic view of the annular ridge in the common marmoset heart. In the common marmoset heart, the annular ridge may function as a valve of the superior vena cava ostium, inferior vena cava ostium, and coronary sinus ostium. Present study provides morphological evidence that common marmosets have a valve-like structure in the right atrium.

241 P Wave Morphology in Focal Atrial Tachycardia: An Updated 2020 Algorithm to Predict site of Origin

The 2005 P wave morphology algorithm by Kistler et al was highly accurate in predicting the site of focal atrial tachycardia (AT). An updated algorithm was developed in light of advances in multipolar mapping, recognition of additional AT sites and a renewed interest in the P wave in mapping non PV triggers. To update and prospectively evaluate a P wave morphology algorithm against a contemporary patient cohort who underwent successful AT ablation. The P wave algorithm was modified to improve clinical utility and recognise the spatial limitations of foci within close anatomic proximity at the paraseptal location. This includes CS ostium, perinodal, non-coronary cusp, left (LS) and right septum (RS), and superior mitral annulus. 30 patients with focal AT and unencumbered P waves were included, and the revised algorithm was prospectively evaluated by 3 blinded assessors. Focal AT originated from the RA in 10 (33%), LA in 9 (30%) and paraseptum in 11 (37%). RA sites included crista terminalis (CT) 6, tricuspid annulus (TA) 3, right atrial appendage (RAA) 1; LA cases include left pulmonary vein / left atrial appendage (LPV/ LAA) 2, and right pulmonary vein (RPV) 7. Using the algorithm the correct anatomic location was determined in 93%. Blinded assessors did not identify 4 paraseptal cases due to incorrect interpretation of the terminal positive P wave component (3) and initial negative P wave deflection (1) in lead V1. The revised 2020 P wave morphology algorithm offers a simplified and accurate method of localising the focus for AT.

Assessment of the Relationship Between the Coronary Venous and Arterial Systems Using 256-Slice Computed Tomography.

To investigate the coronary venous system (CVS) and its spatial relationship with coronary arteries by using 256-slice computed tomography (CT). One hundred one patients underwent coronary CT angiography by using a 256-slice CT. In each patient, the CVS and its spatial relationship with coronary arteries were analyzed. We measured the diameters and angulations of the coronary sinus (CS), great cardiac vein, anterior interventricular vein (AIV), left marginal vein, posterior vein of the left ventricle (PVLV), and posterior interventricular vein (PIV), and the distances, respectively, from the CS ostium and from the crossing point to the ostium of corresponding tributaries. The following 5 pairs of veins and arteries had a higher frequency of intersecting compared with others: the CS/great cardiac vein and the left circumflex coronary artery (97.1%), the AIV and the diagonal or ramus branch (92.1%), the PIV and the posterior branch of left ventricle artery (88.1%), the left marginal vein and the circumflex or circumflex marginal (73.9%), and the PVLV and the circumflex or circumflex marginal (31.6%). The other 2 pairs had a higher frequency of running parallel to each other: the AIV and the left anterior descending artery (76.2%) and the PIV and the posterior descending artery (54.4%). Most tributaries were lateral to their corresponding arteries at the crossing point except for the AIV. For the PVLV and PIV, the distances from the crossing point to the ostium of corresponding veins when the veins were lateral to the arteries were smaller than those when the veins were medial to the arteries (P < 0.05). The CVS and its anatomical relationship with the coronary arterial system can be examined with details by using a 256-slice CT, which has important clinical implications.

Effectiveness of T wave alternans testing for risk stratification of ventricular tachyarrhythmias and sudden death in patients with cardiomyopathy

We present the case of a patient with typical atrial flutter treated with radiofrequency ablation of the cavo-tricuspid isthmus, which presented 5 days later with an ECG suggesting an atrial flutter recurrence. However, careful analysis of this ECG demonstrated a potentially different mechanism of the arrhythmia, underlying the importance of a pragmatic approach to ECG interpretation of arrhythmias. A secondary electrophysiological study was performed diagnosing a focal atrial tachycardia with origin at the coronary sinus ostium, in the presence of a blocked cavotricuspid isthmus. RF ablation successfully suppressed the arrhythmia.

ECG quiz

We present the case of a patient with typical atrial flutter treated with radiofrequency ablation of the cavo-tricuspid isthmus, which presented 5 days later with an ECG suggesting an atrial flutter recurrence. However, careful analysis of this ECG demonstrated a potentially different mechanism of the arrhythmia, underlying the importance of a pragmatic approach to ECG interpretation of arrhythmias. A secondary electrophysiological study was performed diagnosing a focal atrial tachycardia with origin at the coronary sinus ostium, in the presence of a blocked cavotricuspid isthmus. RF ablation successfully suppressed the arrhythmia.

P2567First experience of non-invasive and invasive activation maps merge in carto system for topical diagnosis of focal arrhythmias

Abstract Background Correct preoperative topical diagnostics of atrial and ventricular arrhythmias allows for operation time reduction by facilitating the ablation target localization, especially in case of several ectopic sources. Purpose To implement a non-invasive electrocardiographic imaging (ECGI) technique in CARTO system for aiming at topical diagnostics of focal arrhythmias improving. Methods Twelve patients (m/f – 10/2, age (min–max) – 50,5 (32–71)) with focal arrhythmias underwent ECGI in combination with CT or MR imaging. Two subjects had atrial premature contractions (PAC), while ten patients suffered from ventricular premature contractions (PVC) with indications for ablation. Before the ablation procedure Carto LAT mapping was performed in all patients. Using ECGI epi-/endocardial polygonal models of the heart were created, isopotential and activation maps were calculated, uploaded into the Carto system and merged with the CARTO FAM models (Figure 1). Results For six patients with PVC and two patients with PAC, earliest activation zones (EAZs) anatomical locations obtained by invasive and non-invasive methods were the same (RVOT septum, RVOT lateral-anterior and RV lateral-basal walls, right aortic cusp, LVOT, coronary sinus (CS), CS ostium, RA posterior wall), and arrhythmias ablation was successful. Two patients featured coherent EAZs (RV lateral-basal wall and RVOT septum) but a negative ablation outcome. In one patient, EAZs were situated in different anatomical regions: CARTO showed the PVC EAZ in RV septum, whereas Amycard system identified endocardial surface of lateral-basal RV wall. In this patient, PVC was ablated partially. For another patient with MRI late enhancement area in LV lateral wall the EAZs were in the same LV segment but with mismatch in epi/endocardial surface. Conclusion Non-invasive and invasive activation maps merge can improve localization of ablation targets in focal arrhythmias, potentially increasing effectiveness of the EP procedure and reducing operation time.

P2849Prevalence and significance of sustained pulmonary vein isolation in repeat AF ablation procedures

Abstract Introduction Pulmonary vein (PV) reconnection is a common cause of relapse after catheter ablation of atrial fibrillation (AF). However, some patients have AF recurrence despite durable PV isolation. The aim of this study was to assess the PV isolation status at the time of a second catheter ablation (redo) procedure, and its relationship with subsequent AF relapse. Methods Consecutive patients with symptomatic drug-resistant AF who underwent redo procedures from January 2006 to December 2017 were identified in a single-center observational registry. Pulmonary vein isolation status was assessed during the electrophysiologic study with a circular mapping catheter. Additional radiofrequency (RF) energy applications were also recorded. AF relapse was defined as symptomatic or documented AF/atrial tachycardia/atrial flutter after a 3-month blanking period. Results We identified 240 patients (77 [32%] females, median age 61 [IQR 53–67] years, 85 [35%] with non-paroxysmal AF) undergoing redo procedures during the study period. At the time of redo, 17 (7%) of the patients presented bidirectional conduction block of all PVs. PV reconnection occurred in 157 (65%) of cases in the left superior vein, 142 (59%) in the left inferior vein, 177 (73%) in the right superior vein, and 163 (68%) in the right inferior vein (table). All of the PVs were reconducted in 91 (38%) patients. Additional RF applications were performed in the left atrium (LA) roof, LA posterior wall, cavotricuspid isthmus, mitral isthmus, superior vena cava, coronary sinus, and left atrial appendage ostium, at the operator's discretion (table 1). Over a median follow-up of 2-years (IQR 1–5), 126 patients (53%) suffered AF recurrence, yielding a mean relapse rate of 17%/year. In multivariate Cox regression analysis, the lack of PV reconnection at the time of redo emerged as an independent predictor of subsequent relapse (HR 1.97, 95% CI 1.12–3.49, p=0.019) even after adjustment for univariate predictors including non-paroxysmal AF, body mass index, female sex, and active smoking. Conclusion In patients undergoing redo AF ablation procedures, less than 10% present with complete PV isolation. Despite being relatively infrequent, this finding is independently associated with greater likelihood of subsequent recurrence, suggesting that other mechanisms, not fully addressed by additional RF applications, are at play.

Computed tomography for transcatheter tricuspid valve development.

Patients with severe symptomatic tricuspid regurgitation (TR) are often deemed ineligible for surgical valve repair due to comorbidities. In this setting, transcatheter tricuspid valve replacement (TTVR) is undergoing development, but delivery technique and prosthesis design have yet to be optimized. We sought to assess the challenges of TTVR and the determinants of venous route using computed tomography (CT) analysis. A total of 195 end-diastolic cardiac CT performed prior to surgical correction of a severe TR (n = 38), transcatheter aortic valve replacement (n = 89), or left atrial appendage closure (n = 68) were analyzed. Patients with TR (n = 68; 19 primary and 49 secondary) were compared with patients without (n = 127). Continuous variables with normal and non-normal distributions were compared using Student t test or Mann-Whitney test respectively. The angle from the tricuspid annulus (TA) to the inferior vena cava was tighter (mean = 101 ± 18°) with a broader range of value (44° to 164°) than to the superior vena cava (mean = 143 ± 9°). Patients with TR had rounder TA (eccentricity index of 0.88 ± 0.08, p < 0.001), with a larger area (p < 0.0001), and septolateral (45.3 ± 8.0mm, p < 0.0001) and anteroposterior (44.4 ± 7.4mm, p < 0.0001) diameters than patients without. The distances from the TA to the coronary sinus, the right ventricular outflow tract, and the moderator band were respectively 11.4 ± 3.8mm, 17.2 ± 3.4mm, and 31.0 ± 6.7mm, without differences between groups. The transjugular access for TTVR is straighter and more reproducible than the transfemoral access. Prosthesis development may be challenged by the close position of the coronary sinus, the presence of a moderator band, and the large TA size of patients with severe TR. • The tricuspid annulus is larger in patients with severe tricuspid regurgitation, confirming existing data. • The coronary sinus ostium is close to the tricuspid annulus, requiring a prosthesis with a short atrial length. • The transjugular venous route may be the preferred access to the tricuspid annulus, straighter with less inter-individual variations than the transfemoral route.

Morphology of the Vieussens valve and its imaging in cardiac multislice computed tomography.

To deliver accurate morphological descriptions of the Vieussens valve (VV) and to investigate whether this structure could be visualized using standard contrast-enhanced electrocardiogram-gated multislice computed tomography (MSCT). A total of 145 human autopsied hearts and 114 cardiac MSCT scans were examined. The VV was observed in both study groups, however, the detection rate was significantly worse in the MSCT examination (18.4% in MSCT vs 62.1% in cadavers, P < .0001). The VV height was larger in MSCT patients (2.8 ± 1.2 vs 5.4 ± 1.7 mm; P < .0001). No significant difference was found in the measured distance between the VV and the coronary sinus ostium between the two separate subgroups (27.3 ± 9.5 vs 24.4 ± 5.8 mm; P = .18). In autopsied material the most frequent valve location was the anterior wall of the coronary sinus (43.3%); the same was observed in MSCT scans (71.4%). The VV is a common heart structure, present in over 60% of humans, located mainly on the anterior and superior circuit of the coronary sinus, with relatively high morphological variability. Large VVs, which pose a significant obstacle in catheterization procedures, may be visualized using standard-protocol contrast-enhanced cardiac MSCT.

Morphological and Clinical Significance of Thebesian Valve Guarding Ostium of Coronary Sinus

Abstract Background The advent of novel therapeutic techniques require cannulation of coronary sinus. The Thebesian valve guarding the ostium of coronary sinus can pose practical difficulties during such procedures. Aim With this background we undertook a detailed study of the morphological features of Thebesian valve, so that we can substantially evaluate the clinicoanatomical importance of it. Materials and Methods Fifty human dissected cadaveric heart specimens were selected from the department of anatomy, SDM College of Medical Sciences and Hospital, Dharwad. The location of ostium of coronary sinus and the occurrence of the Thebesian valve and its shape, composition, and extent of occlusion of the ostium were carefully observed and noted. Results Our observations revealed that 90% of specimens had the Thebesian valve guarding the opening of coronary sinus. It was semilunar in shape in 74% of specimens. The valve was membranous in composition in 46% of specimens. Among these, in 26% of specimens the valve almost covered more than 50% of the ostium of coronary sinus indicating moderate to severe occlusion.

Multimodality imaging for real-time image-guided left ventricular lead placement during cardiac resynchronization therapy implantations

This study was performed to evaluate the feasibility of intra-procedural visualization of optimal pacing sites and image-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT). In fifteen patients (10 males, 68 ± 11 years, 7 with ischemic cardiomyopathy and ejection fraction of 26 ± 5%), optimal pacing sites were identified pre-procedurally using cardiac imaging. Cardiac magnetic resonance (CMR) derived scar and dyssynchrony maps were created for all patients. In six patients the anatomy of the left phrenic nerve (LPN) and coronary sinus ostium was assessed via a computed tomography (CT) scan. By overlaying the CMR and CT dataset onto live fluoroscopy, aforementioned structures were visualized during LV lead implantation. In the first nine patients, the platform was tested, yet, no real-time image-guidance was implemented. In the last six patients real-time image-guided LV lead placement was successfully executed. CRT implant and fluoroscopy times were similar to previous procedures and all leads were placed close to the target area but away from scarred myocardium and the LPN. Patients that received real-time image-guided LV lead implantation were paced closer to the target area compared to patients that did not receive real-time image-guidance (8 mm [IQR 0–22] vs 26 mm [IQR 17–46], p = 0.04), and displayed marked LV reverse remodeling at 6 months follow up with a mean LVESV change of −30 ± 10% and a mean LVEF improvement of 15 ± 5%. Real-time image-guided LV lead implantation is feasible and may prove useful for achieving the optimal LV lead position.

Challenging Implants Require Tools and Techniques Not Tips and Tricks.

The EP Clinics article "How to implant CRT devices in a busy clinical practice" describes the basics of the "interventional telescoping technique". This article focuses on specific circumstances where the tools and techniques are invaluable: (1) inability to locate the coronary sinus (CS), (2) inability to advance a catheter into the CS, (3) patients with CS atresia, (4) unstable CS access, (4) angulated target veins, (5) small and/or tortuous target veins, (6) target veins into which a wire cannot be advanced, (7) target veins with a drain pipe takeoff, (8) target veins close to the CS ostium.

Improved Angina Symptoms Following Coronary Sinus Flow Reducer Implantation in a Patient with Refractory Angina and Chronic Total Occlusion: A Case Report

Background: Due to the aging population and increased survival of the patients with coronary artery disease, there is an increasing number of patients with debilitating angina refractory to optimal medical treatment who are not candidates for revascularization. In case of low ischemic load, the treatment of stable refractory angina is aimed at symptom reduction. There are several new treatment methods targeting myocardial ischemia available, including coronary sinus flow reducer (CFR) implantation. Case Report: We report a case of a patient suffering from CCS class IV angina despite optimal medical therapy, with further revascualrization options exhausted, who was successfully treated with coronary sinus flow reducer (CFR). Besides technical skill to reach ostium of coronary sinus, the most important technical tip is precise positioning of the CFR. The reduction of angina symptoms started after epithelisation of CFR frame, usually 6 - 7 weeks after implantation. At 6-month follow-up, the patient reported a marked reduction of angina symptoms, with CCS grade improving by three classes (from IV to I). At 10-month follow-up, the sustainment of CCS grade I angina symptoms was reported by the patient. Conclusions: We conclude that CFR can be safely and successfully implanted in patients suffering from refractory angina. Considerable improvements in CCS grade may be experienced in certain cases.

Safety and effectiveness of coronary sinus leads extraction - single high-volume centre experience.

IntroductionTransvenous leads extraction (TLE) of permanently implanted coronary sinus (CS) leads is widely believed to present greater risks than the removal of other leads.AimTo assess the safety and efficacy of CS leads extraction based on large research material obtained by one operator performing procedures in two TLE centres.Material and methodsWe extracted 408 CS leads from 389 patients, and the results were compared to a control group of 2465 patients who underwent non-CS lead TLE procedures.ResultsThere were no significant differences in the clinical success rate (97.9% vs. 98.0%) or the major complication rate (2.1% vs. 1.8%) between the CS and control group. CS lead destination (LV/LA pacing) and tip location (CS ostium/mid CS /CS tributaries) influenced the procedural and radiological success rates and procedural complexity but not the complications. CS lead extraction did not affect the necessity for a cardiosurgical intervention or presence of procedure-related death.ConclusionsTLE of CS leads can be achieved with a high procedural success rate. The major complication rate is not higher than that seen in non-CS lead extraction patients. More than half of CS leads cannot be removed by simple traction and the use of mechanical sheaths may be necessary. The detachment of CS leads from connective tissue scars in the venous and atrial areas up to the CS ostium is generally sufficient for further removal of the lead using simple traction.

Lessons learned in attempting catheter-based interatrial electrical disconnection for nonpharmacologic rate control of atrial fibrillation or flutter.

Ablation of atrioventricular (AV) conduction and pacemaker implantation is the therapy of last resort for symptomatic atrial tachyarrythmias when rhythm and rate control fail, but is far from ideal. To evaluate whether interatrial electrical disconnection as a result of catheter ablation is feasible and of potential clinical utility as a means of non-pharmacological heart rate control. Eleven patients with medically refractory atrial fibrillation or left atrial flutter and symptomatic rapid ventricular response were included. The ablation strategy consisted primarily of right atrial ablation of the interatrial electrical connections, which were located by electroanatomical activation maps performed during coronary sinus stimulation. Successive activation maps were performed as each connection was blocked. If the procedure was considered unsuccessful AV nodal ablation was performed. The coronary sinus ostium was earliest in 10/11 and could be ablated in 5/10 patients. Interatrial conduction block was only achieved in one patient (9.1%). An unexpected AV nodal modulation with an increase in the Wenckebach cycle length (> 50ms) occurred in 8/11 patients. These patients remained without pacemaker implantation and only 1/8 required AV nodal ablation during the 1-year follow-up. Quality of life questionnaires indicated significant improvement in patients with AV nodal modulation. Interatrial electrical disconnection by right atrial catheter ablation is a not feasible with present day technology. The extensive right atrial septal ablation performed resulted in significant AV nodal modulation in most patients, which persisted and resulted in improvement in quality of life.

Exercise N-13 cardiac positron emission tomography myocardial perfusion imaging detecting ischemia in an adult patient with anomalous aortic origin of the left main coronary artery from the right coronary sinus

Anomalous aortic origin of a coronary artery is a rare congenital condition that has variable presentations from atypical chest pain to syncope and cardiac arrest. Commonly used myocardial perfusion imaging techniques, stress agents, and perfusion agents may have limited ability to detect inducible ischemia in this rare patient group. We herein describe a unique case of anomalous left main coronary artery from a common right coronary sinus ostium with a subpulmonic and intramyocardial course. This patient had multiple atypical chest pain presentations and multiple-negative pharmacologic single-photon emission-computed tomography stress tests performed. Significant ischemia was detected via N-13 exercise cardiac positron emission tomography and with surgical intervention she had resolution of her symptoms.

Feasibility of concomitant vacuum-assisted removal of lead-related vegetations and cardiac implantable electronic device extraction.

Cardiac implantable electronic device (CIED) infections associated with large, mobile vegetation adds to the complexity of lead extraction and is associated with significant patient morbidity and mortality. To show the feasibility of concomitant cardiovascular implantable electronic device extraction and vacuum-assisted removal of lead-related vegetations. This is a single-center retrospective case series of consecutive patients with persistent bacteremia, sepsis, or endocarditis despite medical therapy who have vegetations >2cm and subsequently underwent immediate CIED lead extraction after debulking with vacuum-assisted suction. Eight patients underwent successful removal of 17 leads immediately after debulking of vegetations with vacuum-assisted device suction. Debulking procedure was not successful in 1 patient due to inability to direct the vacuum suction device into proper position. There were no intraprocedure complications related to the vacuum-assisted debulking. One patient required open sternotomy for tear of the coronary sinus ostium related to extraction of a left ventricular pacing electrode. There was no mortality within 30 days of the procedure. Based upon these clinical results, it is feasible for patients with infected CIED systems that have large right-sided vegetations to undergo vacuum-assisted debulking then immediately followed by percutaneous CIED removal in whom surgical removal is considered high risk.

Association of Difference in Coronary Sinus Diameter by Computed Tomographic Angiography Between Patients in and Not in Stable Atherosclerotic Plaque(S).

BackgroundPathological finding fail to describe the morphology of coronary arterial plaques. Retrograde cardiac arteriography is a complicated procedure and does not detect all left posterior and marginal veins of the heart. Magnetic resonance angiography has long scan time and low spatial resolution. The objective of the present study was to assess the possible utility of the difference in coronary sinus diameter to quantify stable atherosclerotic plaque(s) using 256-slice coronary computed tomographic angiography.Material/MethodsA total of 336 patients were divided into 2 groups with 168 patients each. Patients who had heart failure were included in the study group and those who did not were included in the non-study group. Patients were subjected to cross-sectional study. Cardiovascular images were performed with 256-slice coronary computed tomographic angiography with a prospective electrocardiogram and clinical manifestation. Two-tailed paired t test following Dunnett’s multiple comparison tests was performed for the quantitative measurement of coronary computed tomographic angiography and clinical manifestation at 99% confidence level.ResultsThe clinical manifestation did not clearly show cardiac abnormality. The diameters of the superoinferior coronary sinus ostium was than that of the anteroposterior coronary sinus ostium, (p<0.0001, q=26.325). There was the difference in size of the coronary sinus ostium between patients in and not in heart failure (p<0.0001). The study group patients had longer coronary sinuses than patients in the non-study group (p<0.0001).Conclusions256-slice computed tomographic angiography is a feasible and is non-invasive bio-tool for evaluation of coronary artery anatomy.

Dimensions and Angulations of The Coronary Sinus Tributaries: Implications for Left Ventricular Pacing.

BackgroundThe coronary venous system is represented by the coronary sinus (CS) and its tributaries. High variability of the coronary venous tree challenges electrocardiologists. The aim of this study was to evaluate the morphology of CS tributaries, useful and important for invasive procedures, with regards to their angles of entrance to the CS, cannulation distance and ostium diameter.MethodsA total of 200 autopsied human hearts form healthy donors (22% females) were investigated. The ostia of coronary veins to the CS were identified and their diameters were measured. Distances between middle cardiac vein (MCV), posterior vein of left ventricle (PVLV) and left marginal vein (LMV) ostium and CS ostium (cannulation distance) and angles between coronary veins and CS long axis were evaluated. To simulate clinical procedures during measurements 8‐ and 7‐French catheters were used. This study has been conducted in conformance with the Basic Principles of the Declaration of Helsinki and their expansion.ResultsSmall cardiac vein was absent in 52 examined hearts (26.0%). The MCV was present in all assessed specimens. It's mean distance to CS ostium was 5.3±3.2 mm. All MCVs opened to CS, forming with its long axis mean angle of 82.0±12.8°. The average diameter of MCV ostium was 1.8±0.5 mm. The PVLV was observed in 127 hearts (63.5%), two PVLVs was detected in 54 specimens (27.0%) and three PVLVs in 2 hearts (1.0%). In 5 cases (2.5%) a single main PVLV and small ventricular tributaries were observed. The mean distance between CS ostium and the nearest PVLV (from the CS ostium) was 19.7±9.3 mm; second order vein: 27.5±10.4 mm; third order PVLV 31.3±0.1 mm. The mean diameters of PVLVs ostia were: first: 1.2±0.5 mm; second: 1.1±0.6 mm; third: 1.1±0.2 mm. The PVLV entered to the CS at mean angle of: first: 97.0±14.0°; second: 97.9±11.4° and third vein: 117.5±3.5°. The LMV was present in 94 hearts (47.0%). It was either a tributary of CS (17 specimens) or it entered to the GCV (62 hearts). In 15 cases small ventricular tributaries of LMV were detected (7.5%). The mean distance between CS ostium and LMV was 46.0±12.0 mm. It's mean angle was 92.0±13.4° and average LMV ostium diameter was 0.9±0.5 mm.ConclusionIn this research we found MCV with diameter never smaller than 0.5 mm, which makes it quite convenient for electrophysiological procedures. The PVLV was highly variable in number, unfortunately presence of more posterior veins makes it less suitable for cannulation due to smaller diameter. The LMV entering to CS would be potentially more accessible for lead implantation, but those were found only in 8.5% of hearts.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.