Pre-excitation due to accessory sinoventricular connexions associated with coronary sinus aneurysms. A report of two cases.

Gerlis, Leon M.; Davies, Michael J.; Boyle, R; Williams, G. J.; Scott, H. William

doi:10.1136/hrt.53.3.314

Cited by 63 publications

(25 citation statements)

References 12 publications

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“…When the CS progresses into an intimate anatomical relation with the ventricles, it remains possible that extensions of the sinus venosus muscle could be responsible for a physiological connection. 20) Not only CS abnormalities, but also CS dilatation, as shown in the present study, could occur during this development.…”

Section: Cs Diameter and Morphologysupporting

confidence: 72%

Coronary Sinus Morphology in Patients with Posteroseptal Atrioventricular Accessory Pathways

Takenaka

Nakano

Hirao

et al. 2006

Journal of Arrhythmia

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Background: There have been numerous reports about coronary sinus (CS) anomalies related to posteroseptal accessory pathways (APs). The purpose of this study was to explore the diameter and morphology of CS in patients with posteroseptal APs.Methods: We performed direct CS angiography in 105 patients with 22 posteroseptal APs and 83 APs in other regions, and 25 control subjects. We compared the diameter of the CS ostium in all subjects, and assessed the correlation of the local activation time in the patients with posteroseptal APs.Results: The proximal size (diameter) of the CS in the patients with posteroseptal APs (13:6 AE 1:1 mm) was larger than that in the patients with other types of APs (10:2 AE 1:8 mm [p < 0:001]) and that in the control subjects (9:6 AE 1:5 mm [p < 0:001]). Dilatation of the CS in the patients with posteroseptal APs extended up to 20 mm inside the CS. In 15 (68%) of the patients with posteroseptal APs, the proximal site of the CS demonstrated a windsock appearance.Conclusions: We concluded that the larger size and the wind cone appearance of proximal CS were unique structural characteristics in most patients with posteroseptal APs. (J Arrhythmia 2006; 22: 149-154)

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Section: Cs Diameter and Morphologysupporting

confidence: 72%

Coronary Sinus Morphology in Patients with Posteroseptal Atrioventricular Accessory Pathways

Takenaka

Nakano

Hirao

et al. 2006

Journal of Arrhythmia

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“…The generation of some atrial arrhythmias may relate to the spiral sheath of myocardium surrounding the CS and its connections to the right and left atria. The muscle sheath may represent a remnant of the sinus venosus (Gerlis et al, 1985). In electrophysiological studies performed in canine hearts, Antz et al showed that the CS musculature is electrically connected to the right and left atrium.…”

Section: Discussionmentioning

confidence: 99%

Anatomic and Histologic Review of the Coronary Sinus

Barceló¹,

Fuente²,

Stertzer³

2004

Int. J. Morphol.

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SUMMARY:The coronary sinus (CS), traditionally considered merely a great cardiac vein, is shown to display anatomic characteristics of a true cardiac chamber: endocardium, striated myocardium, epicardium and a specific conduction system. Fourteen human hearts were dissected with optical magnification. High resolution pictures were taken with a digital camera. The data was analyzed with specialized computer software.Macroscopic findings: 1) the existence of striated myocardial muscle forming the wall of the CS over its entire circumference, 2) muscular CS-atrial connections and, 3) an previously undescribed muscular atrio-coronary sinus bundle. Two muscular tracts linking the CS to the right atrium (RA), (one antero-superior or septal, and another postero-inferior or atrial) were discovered as well. Microscopic findings: 1) striated myocardial fibers in the media and, 2) a group of cells similar to the P cells of the sinus node, in addition to a large number of Purkinje-like cells. Numerous groups of ganglionic neurons were identified in the subepicardium.In addition to its venous transport function, the CS is a discrete, cameral structure situated in the left posterior sulcus, and not intramural to the atrium or ventricle. The findings suggest that Bachmann's bundle, the atrio-coronary sinus bundle, the CS musculature and the right atrium may all be part of the conduction system, and contribute to the genesis of cardiac arrhythmias. The CS is therefore a small cardiac chamber that joins the other four chambers at the level of the crux cordis.

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“…C oronary sinus (CS) diverticula [1][2][3][4][5] have been associated with posteroseptal and left posterior accessory pathways. These diverticula contain myocardial fibers that connect to both the ventricle and the CS myocardial coat.…”

mentioning

confidence: 99%

“…These diverticula contain myocardial fibers that connect to both the ventricle and the CS myocardial coat. 1,2 The CS myocardial coat, present in all individuals, 6 is anatomically 6 -9 and electrically 10 connected to both atria, completing the accessory connection.…”

mentioning

confidence: 99%

Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways

et al. 2002

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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 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. Conclusions-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.

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Pre-excitation due to accessory sinoventricular connexions associated with coronary sinus aneurysms. A report of two cases.

Cited by 63 publications

References 12 publications

Coronary Sinus Morphology in Patients with Posteroseptal Atrioventricular Accessory Pathways

Coronary Sinus Morphology in Patients with Posteroseptal Atrioventricular Accessory Pathways

Anatomic and Histologic Review of the Coronary Sinus

Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways

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