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Cardiac Masses
Published in Takahiro Shiota, 3D Echocardiography, 2020
Sonia Velasco del Castillo, Miguel Angel García-Fernández
The crista terminalis is a fibromuscular structure that extends from the superior to the inferior vena cava separating the smooth posterior wall of the right atrium from the trabeculae anterior wall. If this structure is very marked, it can simulate a mass in the posterior wall of the right atrium, simulating thrombus or myxoma. The 2D and 3D TEE allows us to see its relationship with neighboring structures, its echogenicity similar to the atrial endocardium and the absence of infiltrative data, allowing a differential diagnosis to be made quite easily.
Thorax
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Right atrium The right atrium receives venous blood via the superior and inferior venae cavae, coronary sinus and the anterior cardiac veinThe septal wall has the fossa ovalis, a shallow depression which indicates the site of the foramen ovaleThe crista terminalis is a ridge that runs vertically downwards between the venae caval openings and marks the boundary between the smooth-walled posterior part of the atrium and the trabeculated anterior portion (formed by pectinate muscles)
Atrial Flutter
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Ayman A. Hussein, Oussama M. Wazni
Re-entrant circuits include normal anatomic boundaries such as the tricuspid ring or mitral ring, and orifices of the superior vena cava (SVC) or inferior vena cava (IVC). Functional barriers are created due to an inability to conduct action potentials as rapidly as that seen in AFL. In 1980, Spach13 suggested that the right atrium is able to support re-entry due to anisotropic conduction. The crista terminalis (CT) is a thick bundle of myocardial fibers that run in a superior/inferior direction, extending from the roof of the right atrium adjacent to the SVC opening laterally and inferiorly to the IVC. This band of tissue is able to conduct rapidly in the longitudinal direction but very slowly in the transverse direction, which is due to relative abundance of gap junctions in the longitudinal versus transverse direction, in a 10:1 ratio. This property allows for a functional transverse barrier. The openings of the IVC and the SVC linked by the CT provide a posterior obstacle to conduction, the tricuspid orifice (TR) provides an anterior obstacle; and this creates a ring that is able to support re-entry in either a clockwise or counterclockwise direction.9,11 The isthmus between the IVC and TR, called the cavotricuspid isthmus (CTI) is often targeted with ablation and flutters which use this critical isthmus are often referred to as CTI-dependent AFLs and are the most commonly encountered AFLs in clinical practice, especially in patients with no prior history of cardiac surgery or ablation procedures.
Unipolar atrial electrogram morphology is affected by age: evidence from high-resolution epicardial mapping
Published in Annals of Medicine, 2023
Ziliang Ye, Mathijs S. van Schie, Annejet Heida, Lianne N. van Staveren, Frank R. N. van Schaagen, Yannick J. H. J. Taverne, Natasja M. S. de Groot
However, current data on age-related changes in electrogram (EGM) morphology is limited to the RA. Kistler et al. [6] demonstrated in 41 patients that ageing was related to a larger number of double and fractionated potentials along the crista terminalis. However, it is unknown which features of EGM morphology are affected by ageing and whether the age-related changes in EGM morphology are equally distributed throughout the right and left atria (LA). The purpose of this study is therefore to investigate the influence of age on unipolar atrial EGM (U-AEGM) morphology recorded from the RA and LA including BB in a large cohort of patients undergoing cardiac surgery.
Hybrid and surgical procedures for the treatment of persistent and longstanding persistent atrial fibrillation
Published in Expert Review of Cardiovascular Therapy, 2018
Jose M. Sanchez, Ghannam Al-Dosari, Sherman Chu, Ramin Beygui, Tobias Deuse, Nitish Badhwar, Randall J. Lee
Non-PV triggers are also central to the mechanism of AF initiation and are commonly targeted for ablation in those undergoing PVI. These triggers can be present in paroxysmal and persistent forms of AF and include the LAA, posterior wall of LA, the superior vena cava, crista terminalis, fossa ovalis, CS, Eustachian ridge, ligament of Marshall, and area adjacent to the AV valve annuli. There is a suggested improved outcome after elimination of non-PV triggers for persistent AF and those who undergo repeat ablations where the PVs all remain isolated, but efficacy rates of only approximately 65% can be achieved despite the multiple catheter ablation procedures [17]
Focal activation patterns: breaking new grounds in the pathophysiology of atrial fibrillation
Published in Expert Review of Cardiovascular Therapy, 2018
Rohit K. Kharbanda, Eusebio Garcia-Izquierdo, Ad J.J.C. Bogers, Natasja M.S. De Groot
FAPs during induced AF have also been observed in various animal models including heart failure and hypertension-induced AF model (Table 2). These patterns emerged frequently from the crista terminalis or the PVR and occasionally from the vein of Marshall [23–25]. Strikingly, all studies performed in the goat model found only solitary FAPs in both atria [26,27].