Spatial relationship of coronary sinus–great cardiac vein to mitral valve annulus and left circumflex coronary artery: implications for cardiovascular interventional procedures

Randhawa, Mandeep Singh; Saini, Abhimanyu; Aggarwal, Anjali; Saikia, Uma Nahar; Tubbs, R. Shane; Gupta, Tulika; Rohit, Manoj Kumar; Kalyan, Gurdeep Singh; Sahni, Daisy

doi:10.1016/j.carpath.2016.06.001

Cited by 7 publications

(4 citation statements)

References 32 publications

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“…It has been proposed that differing configurations of blood vessels within the isthmus line could complicate ablation procedures via different mechanisms . For instance, in anomalous variations, the intramural blood flow (especially within the coronary sinus) could act as an epicardial “heat‐sink.” More specifically, these vessels could remove heat from the ablation site via convective cooling, all the while reducing the efficacy of isthmus ablation .…”

Section: Discussionmentioning

confidence: 99%

Topographic characteristics of the left atrial medial isthmus

Piątek‐Koziej

Hołda

Bolechała

et al. 2019

Pacing Clinical Electrophis

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Background The purpose of this study was to provide detailed topography of the left atrial medial isthmus (situated between the right inferior pulmonary vein ostium and the medial part of the mitral annulus). Methods Two hundred human hearts (Caucasian, 22.5% females, 48.7 ± 4.9 years old) were investigated. Results The mean length of the medial isthmus was 42.4 ± 8.6 mm. Additionally, the medial isthmus line was divided by the oval fossa into three sections with equal mean lengths (upper: 14.2 ± 7.2 vs middle: 14.1 ± 6.1 vs lower: 14.9 ± 4.6 mm; P > .05). The left upper section of the atrial wall was thinner than the lower section (2.5 ± 1.1 vs 3.4 ± 1.6 mm; P < .0001). This study noted three separate spatial arrangements of the isthmus line. Type I (54.5%) had an oval fossa located outside the isthmus line; type II (32.5%) had an oval fossa crossed by the isthmus line, and type III (13.0%) had an oval fossa rim located tangentially to the isthmus line. In 68.5% of the examined specimens, the isthmus area had a smooth surface. Conversely, the remaining 31.5% had additional structures within its borders such as diverticula, recesses, and tissue bridges. Conclusion This study is the first to describe the morphometric and topographical features of the left atrial medial isthmus. Interventions within the medial isthmus line should be performed cautiously, especially when they are transected by the oval fossa (32.5%). Careful navigation of the area is also recommended due to the possibility of existent additional structures. The latter could lead to catheter entrapment during ablation procedures.

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Section: Discussionmentioning

confidence: 99%

Topographic characteristics of the left atrial medial isthmus

Piątek‐Koziej

Hołda

Bolechała

et al. 2019

Pacing Clinical Electrophis

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“…The artery is present within the LAA line in almost all cases (96.5%), but only in 57.0% in the mitral isthmus line (Hołda et al, ). The prevalence of the left circumflex artery decreases gradually in further sections of the atrioventricular groove (Randhawa et al, ). The mean diameter of the artery also gradually decreases, and there is already a significant difference within the mitral isthmus line (2.6 ± 0.9 vs.2.3 ± 1.0 mm, P = 0.01) (Hołda et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The great cardiac vein was found within the LAA isthmus area in 75% of patients, and in almost all hearts within the mitral isthmus section and closer to the interatrial septum parts of the left atrial wall (whether the great cardiac vein or the coronary sinus) (Randhawa et al, ; Hołda et al, ). Not surprisingly, the venous vessel was narrower within the LAA isthmus than the mitral isthmus (2.6 ± 1.0 vs.4.1 ± 1.2 mm, P < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

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

Hołda

Strona

et al. 2018

Clinical Anatomy

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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.

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“…As mentioned above, blood vessels do not lie at the level of the mitral valve annulus but slightly above it [22]. The coronary sinus/great cardiac vein is located farthest from the annulus in the vertical plane in the middle of its course and in the horizontal plane at its beginning [43]. The artery dimensions diminish anteriorly to posteriorly, while the coronary sinus parameters increase in this direction.…”

Section: Left Circumflex Artery and Coronary Sinus In The Aspect Of Mitral Valve Repair Proceduresmentioning

confidence: 94%

Clinical anatomy of human heart atria and interatrial septum — anatomical basis for interventional cardiologists and electrocardiologists. Part 2: left atrium

Ciuk¹,

Janas

Klimek‐Piotrowska

2018

Kardiol Pol

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Spatial relationship of coronary sinus–great cardiac vein to mitral valve annulus and left circumflex coronary artery: implications for cardiovascular interventional procedures

Cited by 7 publications

References 32 publications

Topographic characteristics of the left atrial medial isthmus

Topographic characteristics of the left atrial medial isthmus

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

Clinical anatomy of human heart atria and interatrial septum — anatomical basis for interventional cardiologists and electrocardiologists. Part 2: left atrium

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