Topography of the oblique vein of the left atrium (vein of Marshall)

Żabówka, Anna; Jakiel, Marcin; Bolechała, Filip; Jakiel, Rafał; Jasińska, Katarzyna A.; Hołda, Mateusz K.

doi:10.33963/kp.15318

Cited by 10 publications

(7 citation statements)

References 10 publications

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“…Heart weight was increased in subjects with a history of AF and with documented immediate cardiovascular cause of death. Lastly, the mean length of the patent VOM from its ostium was 32.83 AE 5.18 mm, which is consistent with a previous study (30.8 AE 13.6 mm) [15].…”

Section: Major Findingssupporting

confidence: 92%

The autonomic nerves around the vein of Marshall: a postmortem study with clinical implications

Depes,

Mennander,

Immonen

et al. 2024

APMIS

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This study aims to analyze the vein of Marshall (VOM) in human autopsy hearts and its correlation with clinical data to elucidate the morphological substrates of atrial fibrillation (AF) and other cardiac diseases. Twenty‐three adult autopsy hearts were studied, assessing autonomic nerves by immunohistochemistry with tyrosine hydroxylase (sympathetic nerves), choline acetyltransferase (parasympathetic nerves), growth‐associated protein 43 (neural growth), and S100 (general neural marker) antibodies. Interstitial fibrosis was assessed by Masson trichrome staining. Measurements were conducted via morphometric software. The results were correlated with clinical data. Sympathetic innervation was abundant in all VOM‐adjacent regions. Subjects with a history of AF, cardiovascular cause of death, and histologically verified myocardial infarction had increased sympathetic innervation and neural growth around the VOM at the mitral isthmus. Interstitial fibrosis increased with age and heart weight was associated with AF and cardiovascular cause of death. This study increases our understanding of the cardiac autonomic innervation in the VOM area in various diseases, offering implications for the development of new therapeutic approaches targeting the autonomic nervous system.

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Section: Major Findingssupporting

confidence: 92%

The autonomic nerves around the vein of Marshall: a postmortem study with clinical implications

Depes,

Mennander,

Immonen

et al. 2024

APMIS

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“…However, the VOM exactly lies at the corresponding epicardial aspect of this tough region. In previous reports, Żabówka et al 16 categorized the VOM into 4 types from observations of 200 autopsied adult human hearts: extended below the level of the LIPV (21.9%); to the level of the LIPV (47.7%); to the level of the interpulmonary area (17.2%); and to the level of the LSPV (13.3%). Valderrábano et al 17 also demonstrated that VOM was visible up to the level of LIPV in 72.8% patients, and went past the LIPV, reaching the LSPV in 9.6% of patients.…”

Section: Discussionmentioning

confidence: 99%

The adjunctive effect for left pulmonary vein isolation of vein of Marshall ethanol infusion in persistent atrial fibrillation

et al. 2022

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Objective This study sought to assess the effect of ethanol infusion into the vein of Marshall (EIVOM) on the acute success of left pulmonary vein (LPV) isolation in persistent atrial fibrillation (PeAF). Methods and results A total of 313 patients with drug-resistant PeAF were enrolled (135 in Group 1 and 178 in Group 2). In Group 1, EIVOM was firstly performed, followed by radiofrequency ablation (RFA) including bilateral pulmonary vein isolation (PVI) and linear ablation at roofline, cavotricuspid isthmus, and mitral isthmus (MI). In Group 2, PVI and linear ablations were completed with RFA. First-pass isolation of the LPV was achieved in 119 (88.1%) and 132 (74.2%) patients in Groups 1 and 2, respectively (P = 0.002). The rate of acute pulmonary vein reconnection (PVR) was significantly lower in Group 1 (9.6% vs. 22.5%, P = 0.003). About half of acute PVR occurred in the carina with or without EIVOM. Conclusion EIVOM is effective in achieving a higher first-pass isolation and a lower acute PVR of LPV in PeAF.

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“…The LOM forms the neural connecting pathway between intrathoracic and intracardiac ganglia with abundant (para) sympathetic to atrial connections that have an interesting topographical neural density variation along the ligament ( 5 , 12 ). Additionally, the LOM contains the vein of Marshall, which is electrically connected to the CS through its muscular sleeve and to the LA free wall through Marshall bundles ( 1 , 3 – 10 ). LOM activation patterns differ between patients, which is caused by differences in LOM anatomy and the number of connections between the LOM and the surrounding tissue, as demonstrated by Han et al ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…This is now known as the ligament of Marshall (LOM), which results from embryonic obliteration of the left anterior cardinal vein when the venous system transfers from a symmetric to a right-sided one ( 2 ). The LOM contains the vein of Marshall (VOM)—which is also referred to as the oblique vein of the LA—, small sympathetic and parasympathetic nervous fibers, and multiple myocardial tracts toward the LA free wall, known as Marshall bundles ( 1 , 3 – 10 ). As a consequence, the LOM is much more than just an embryological remnant: it forms an electro-anatomical connection between the coronary sinus (CS), the left lateral ridge, and the PVs.…”

Section: Introductionmentioning

confidence: 99%

Optimization of intra-operative electrophysiological localization of the ligament of Marshall

Langmuur

Taverne²,

Schie³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe ligament of Marshall (LOM) may play a role in the pathophysiology of several tachyarrhythmias and accurate electrophysiological localization of this structure is crucial for effective ablation therapy. This study therefore quantifies electrophysiological properties of the LOM, and identifies which electrogram (EGM) recording (uni- or bipolar) and processing technologies [local activation time (LAT) and/or voltage mapping] are most suitable for accurate localization of the LOM.MethodsThe LOM was electrophysiologically identified in 19 patients (mean age 66 ± 14 years; 12 male) undergoing elective cardiac surgery using intra-operative high-density epicardial mapping, to quantify and visualize EGM features during sinus rhythm.ResultsOnly a third of LOM potentials that were visualized using unipolar EGMs, were still visible in bipolar activation maps. Unipolar LOM potentials had lower voltages (P50: LOM: 1.51 (0.42–4.29) mV vs. left atrium (LA): 8.34 (1.50–17.91) mV, p < 0.001), less steep slopes (P50: LOM: –0.48 (–1.96 to –0.17) V/s vs. LA: –1.24 (–2.59 to –0.21) V/s, p < 0.001), and prolonged activation duration (LOM: 20 (7.5–30.5) ms vs. LA: 16.5 (6–28) ms, p = 0.008) compared to LA potentials. Likewise, bipolar LOM voltages were also smaller (P50: LOM: 1.54 (0.48–3.28) mV vs. LA: 3.12 (0.50–7.19) mV, p < 0.001).ConclusionThe LOM was most accurately localized in activation and voltage maps by using unipolar EGMs with annotation of primary deflections in case of single potentials and secondary deflections in case of double or fractionated potentials.

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Topography of the oblique vein of the left atrium (vein of Marshall)

Cited by 10 publications

References 10 publications

The autonomic nerves around the vein of Marshall: a postmortem study with clinical implications

The autonomic nerves around the vein of Marshall: a postmortem study with clinical implications

The adjunctive effect for left pulmonary vein isolation of vein of Marshall ethanol infusion in persistent atrial fibrillation

Optimization of intra-operative electrophysiological localization of the ligament of Marshall

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