Clinical Anatomy of the Cavotricuspid Isthmus and Terminal Crest

Klimek‐Piotrowska, Wiesława; Hołda, Mateusz K.; Koziej, Mateusz; Hołda, Jakub; Piątek, Katarzyna; Tyrak, Kamil; Bolechała, Filip

doi:10.1371/journal.pone.0163383

Cited by 28 publications

(42 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19 When observed from the inferior aspect, the vestibule of the RAA is separated from the cavotricuspid isthmus by the final ramifications of the terminal crest. 4 From the superomedial aspect, it extends freely into the anteroinferior region of the interatrial septum and into the area of Koch's triangle. 6,7,20 To date, the most complex macroscopic study of this structure has been performed by Ueda et al, 10 which analyzed 39 normal human hearts.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

Hołda

Słodowska

Tyrak

et al. 2020

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

Introduction: The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures. Methods and Results: We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001). Conclusions: This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.

show abstract

Section: Discussionmentioning

confidence: 99%

“…5 As a result, the important morphological features of the cavotricuspid isthmus, Koch's triangle, and the interatrial septal region have been thoroughly studied. 4,6,7 However, little is known about the vestibule and the isthmuses of the RAA.…”

Section: Introductionmentioning

confidence: 99%

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

Hołda

Słodowska

Tyrak

et al. 2020

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…5 ). In contrast, the CSO in humans is present in the cavotricuspid isthmus, between the Eustachian valve/ridge and the tricuspid valve [ 12 ]. Although the coronary sinus valve (Thebesian valve) is present at the edge of the CSO in 62–85% of human adults [ 13 ], the Thebesian valve was not identified in the marmosets studied in the present study ( Fig.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…It should also be emphasized that the article‐thin atrial wall, which is usually observed in the mitral isthmus area (especially inside the crevices or recesses), rarely appears within the LAA isthmus region, where the wall is significantly thicker (Cabrera et al, ; Hołda et al, ). Also, in the region of the cavotricuspid isthmus, we should expect a very thin area within the posterior (or membranous) part of the isthmus (Klimek‐Piotrowska et al, ). No segmental narrowing of the left atrial wall is observed in the LAA isthmus, which is common for the middle sector of the mitral isthmus (7.5% of all cases), where the whole atrial wall is <0.8 mm thick (Hołda et al, ).…”

Section: Discussionmentioning

confidence: 99%

Blood Vessels and Myocardial Thickness within the Left Atrial Appendage Isthmus Line

Hołda

Strona

et al. 2018

Clinical Anatomy

Self Cite

View full text Add to dashboard Cite

Electric isolation of the left atrial appendage (LAA) and linear ablations in the area of the LAA base are gaining popularity. However, very little is known about the myocardial architecture and the presence of epicardial blood vessels within this region, which could significantly influence the course of such procedures. We examined 200 autopsied hearts (22.5% females, 46.7 ± 16.8 years old). The LAA isthmus (i.e., the line between the LAA ostium and the mitral annulus) was cut longitudinally. The myocardium was thickest at the LAA end of the isthmus (2.4 ± 0.7 mm) followed by its middle sector (2.1 ± 0.7 mm) inside the LAA, 5 mm from its ostium (1.9 ± 0.7 mm), and the mitral annulus end of the isthmus (1.8 ± 0.6 mm) (P < 0.0001). At least one artery was found in 96.5% of all samples (89.5% were single branched, 7% had two branches). The great cardiac vein was found in 77.0% and the left marginal vein in 2.5%. The artery was interposed between the endocardium and the great cardiac vein in 31.5% of cases. The smallest distance between the endocardium and the artery was 0.5 mm and between the endocardium and the vein was 0.7 mm. In total, we were able to distinguish fifteen different types of vascular arrangements within the LAA isthmus line in this study. The myocardium within the LAA isthmus is thickest at its LAA end. The left circumflex coronary artery branches are the most frequently‐occurring vessels within the isthmus and are present in almost all cases, while the great cardiac vein is present in three quarters of hearts. Clin. Anat. 31:1024–1030, 2018. © 2018 Wiley Periodicals, Inc.

show abstract

Clinical Anatomy of the Cavotricuspid Isthmus and Terminal Crest

Cited by 28 publications

References 19 publications

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

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

Blood Vessels and Myocardial Thickness within the Left Atrial Appendage Isthmus Line

Contact Info

Product

Resources

About