Myocardial coverage of the coronary sinus and related veins

Lüdinghausen, Michael von; Ohmachi, Nobuko; Boot, Christine

doi:10.1002/ca.980050102

Cited by 109 publications

(72 citation statements)

References 12 publications

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“…A previous detailed anatomic study documented the presence of a myocardial cover of the coronary sinus in 240 human hearts. 16 In all specimens, the myocardial coat also covered the adjacent 2 to 11 mm of the great cardiac vein and was sometimes thickened in a sphincter-like fashion. The valve of Vieussens was found in 87% of cases, whereas the ostium of the oblique vein was a more constant marker for determining the beginning of the coronary sinus.…”

Section: Chauvin Connections Between Coronary Sinus and Left Atriummentioning

confidence: 87%

“…12,13 In epicardial mapping studies, Boineau et al 14 confirmed such a breakthrough in the region of the coronary sinus. Scherlag et al 15 described a left atrial tract within the ligament of Marshall that originated from the coronary sinus ostium, and a study by Ludinghausen et al 16 reported the anatomic features of the myocardial cover of the coronary sinus. The precise features of this interatrial link through the coronary sinus have not been defined.…”

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confidence: 99%

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The Anatomic Basis of Connections Between the Coronary Sinus Musculature and the Left Atrium in Humans

et al. 2000

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Background-This study determined the histological features of the atrial myocardium connecting the coronary sinus and the left atrium in humans. Methods and Results-Ten necropsied hearts were studied by performing serial longitudinal sections parallel to the long axis of the coronary sinus that extended its full length using a large microtome. In all specimens, the venous wall of the coronary sinus was surrounded by a cuff of striated muscle extending 40Ϯ8 mm from the ostium. Striated myocardial connections of varying number and morphology left this coronary muscle cuff and connected to the left atrium; they ranged from 1 to 2 fascicles to a widely intermingled continuum (thickness, 2.79Ϯ2 mm; width, 2.91Ϯ3.5 mm). These connections originated 8.8Ϯ5.7 mm from the coronary sinus ostium and inserted 18Ϯ11 mm distally into the left atrium. The insulating compartment in which the connections traversed between the left atrium and the coronary sinus was mostly formed of adipose tissue. The valve of Vieussens was found in 6 hearts at a mean distance of 3.4Ϯ3.2 mm from the distal extremity of the coronary sinus muscle cuff. Conclusions-In the human heart, a consistent but morphologically variable left atrial coronary sinus myocardial connection was found. This emphasizes the need for surgical dissection or catheter ablation in or around the coronary sinus to eliminate these connections. (Circulation. 2000;101:647-652.)

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Section: Chauvin Connections Between Coronary Sinus and Left Atriummentioning

confidence: 87%

mentioning

confidence: 99%

The Anatomic Basis of Connections Between the Coronary Sinus Musculature and the Left Atrium in Humans

et al. 2000

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“…In particular, connections between the muscular wall of the coronary sinus and the remnant of the vein of Marshall to the left atrium are common. 1,8,9 The Neighborhood Parts of the left atrial body, the entrances of the pulmonary veins, the atrial appendage, and the coronary sinus are in close vicinity to important structures that may be affected by interventional maneuvers that are carried out on and within the left atrium. The epicardial aspect of the left atrium, particularly in the region of the veno-atrial junctions, the interatrial groove, the roof, and the tract of the coronary sinus along the inferior wall, is covered by pads of fatty tissues.…”

Section: Interatrial Muscular Connectionsmentioning

confidence: 99%

“…The sleeve covers a length of 25-52 mm and increases in thickness toward the coronary sinus orifice. 8 Muscular continuity between venous walls and the posterior and inferior left atrial wall is common. 1,8,9 The free wall of the coronary sinus, however, is often thin and relatively unprotected.…”

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confidence: 99%

Left Atrial Anatomy Revisited

Cabrera²,

Sánchez‐Quintana³

2012

Circ: Arrhythmia and Electrophysiology

305

249

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R ecent decades have seen rapid developments in arrhythmia treatment, especially the use of catheter ablation. Although the substrates of atrial fibrillation, its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium has become a therapeutic option for patients with this arrhythmia. With ablation techniques, various isolation lines and focal targets are deployed; the majority of these are anatomic approaches. It has been over a decade since we published our first article on the anatomy of the left atrium relevant to interventional electrophysiologists. 1 Our aim then, as now, was to increase awareness of anatomic structures inside the left atrium. In this review of anatomy, we revisit the left atrium, inside as well as outside, for a better understanding of the atrial component parts and the spatial relationships of specific structures. Location and Atrial WallsViewed from the frontal aspect of the chest, the left atrium is the most posteriorly situated of the cardiac chambers. Owing to the obliquity of the plane of the atrial septum and the different levels of the orifices of the mitral and tricuspid valves, the left atrial chamber is more posteriorly and superiorly situated relative to the right atrial chamber. The pulmonary veins enter the posterior part of the left atrium with the left veins located more superior than the right veins. The transverse pericardial sinus lies anterior to the left atrium, and in front of the sinus is the root of the aorta. The tracheal bifurcation, the esophagus, and descending thoracic aorta are immediately behind the pericardium overlying the posterior wall of the left atrium. Further behind is the vertebral column.Following the direction of blood flow, the atrial chamber begins at the pulmonary veno-atrial junctions and terminates at the fibro-fatty tissue plane that marks the atrioventricular junction at the mitral orifice. The walls of the left atrium are muscular and can be described as superior, posterior, left lateral, septal (or medial), and anterior, as suggested by McAlpine, 2 who drew attention to the importance of describing the heart in its anatomic position in the chest, in the orientation he termed "attitudinal," which is the appropriate terminology for cardiac interventionists. 3 The left atrium is relatively smooth-walled on its internal aspect ( Figure 1A), but its walls are not uniform in thickness. The roof or superior wall is in close proximity to the bifurcation of the pulmonary trunk and the right pulmonary artery. The thickness of its muscle component measured transmurally ranges from 3.5 to 6.5 mm (mean, 4.5Ϯ0.6 mm) in formalin-fixed heart specimens. 4 The thickness of the lateral wall ranges between 2.5 and 4.9 mm (mean, 3.9Ϯ0.7 mm). The anterior wall, related to the aortic root, ranges from 1.5 to 4.8 mm (mean, 3.3Ϯ1.2 mm) thick, but it can become very thin at the area near the vestibule ( Figure 1B) of the mitral annulus, diminishing to an average thickness of 2 mm. Importantly, there is an area of the anterio...

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“…In one study of 143 patients, 62.9% presented the valve; in 73 patients the valve had a semilunar shape, in 10 cases a septal shape and in seven cases a shape like a crest [20]. In 39 procedures, there were difficulties SOUZA, FSO ET AL -Technical aspects of lead implantation for left ventricle pacing through the coronary sinus, using anatomic radiology and intracavitary electrography in the cardiac resynchronization therapy with the forward movement of the electrode through the coronary venous sinus, near to the junction of the great cardiac vein, a probable location of the Vissencius' valve as found in 87% of the studied cases by Lundinghausen et al [21], also demonstrating the importance of this valve in the implantation procedure of the coronary sinus electrode.…”

Section: Commentsmentioning

confidence: 99%