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CT Perspective of Normal Cardiovascular Anatomy
Published in Paul Schoenhagen, Frank Dong, Cardiac CT Made Easy, 2023
The coronary venous blood flow drains via the coronary sinus into the RA (Figure 2.6). It originates at the inferior-medical aspect of the RA, and bifurcates into branches extending parallel to the coronary arteries. The largest branch lies inferior to the LA, and then extends as the great cardiac vein along the left AV groove (along the left circumflex artery [LCX]) to the anterior interventricular groove (parallel to the left anterior descending artery [LAD]).
Autopsy Cardiac Examination
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
The coronary veins run with the major arteries and return the blood to the coronary sinus (Fig. 1.13). This drains into the posteroinferior right atrium above the tricuspid valve (Fig. 1.14). The veins form wide, thin channels in both the interventricular and the atrioventricular grooves. The great cardiac vein is formed in the anterior interventricular groove. It then runs around the left AV groove and expands to form the body of the coronary sinus when it is joined by the middle cardiac vein from the posterior interventricular groove draining into the coronary sinus (Figs. 1.13 and 1.14). When the Cx artery is small, the larger, wider great vein can sometimes be mistaken for the circumflex coronary artery in the left AV groove (Fig. 1.15). At the crux, the great cardiac vein merges with the middle cardiac vein, which runs up the posterior interventricular groove and the small cardiac vein to form the coronary sinus (Fig. 1.13). This small cardiac vein initially accompanies the acute marginal artery and runs round the right AV groove before terminating in the coronary sinus at the crux. It is important to examine these veins when retrograde cardioplegia is used in cardiac operations to look for complications such as rupture or thrombosis. The coronary sinus and great vein are closely associated with the mitral annulus and are used for access for catheter ablation of abnormal conduction pathways and cardiac pacing with electrophysiological studies.
Mitral regurgitation, mitral stenosis, and mitral annular calcification in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Hasan Ahmad, Wilbert S. Aronow
Finally, there are constant innovations in cardiac surgery that should make surgery easier on the patient and possibly safer for elderly patients with multiple comorbidities. These include minimally invasive surgery compared to standard thoracotomy (110,111) and robotic surgery (112,113). Catheter interventions have also shown promise in relatively noninvasively repaired MR. Whitlow and colleagues reported on the acute and 1-year results of the Endovascular Valve Edge-to-Edge Repair (EVEREST II) study where the mitral valve is converted into a double orifice by clipping the edges of the two leaflets together using a percutaneous catheter (MitraClip device). Seventy-eight patients, mean age 77 years old, with 3-to-4+ MR who were high risk for surgery had the procedure. At 1 year, the patients had improvement in clinical symptoms and significant left ventricular reverse remodeling (114). Another innovative technique for performing a mitral annuloplasty by transcatheter implantation of a coronary sinus device has been developed. The 1-year results in 59 patients with MR grade ≥2 show a reduction in MR by ≥1 grade. However, there was coronary compression in 15 patients where the great cardiac vein passes over a coronary artery, so strategies for avoiding this occurrence must be developed before this becomes a useful technique (115).
Pericardial Anatomy, Interventions and Therapeutics: A Contemporary Review
Published in Structural Heart, 2021
Reza Reyaldeen, Nicholas Chan, Saberio Lo Presti, Agostina Fava, Chris Anthony, E. Rene Rodriguez, Carmela D. Tan, Walid Saliba, Paul C Cremer, Allan L. Klein
The epicardial vasculature is an important consideration in any intervention utilizing a pericardial approach, in part related to the significant variability of these vessels and potentially hazardous complications. For example, the great cardiac vein crosses the left circumflex artery at the left ventricular summit, and is most commonly superficial to the artery in up to 61% of the time, but can also run deep in up to 37% of patients.15 This variation is important in ablative procedures where an unexpected artery between the vein and myocardium could be devastating.5 Epicardial fat surrounds coronary vessels, which is advantageous by providing protection, however, may impact procedural success by inhibiting effective ablation.5
Retrograde venography and three-dimensional mapping of a great cardiac vein with separate drainage into the high right atrium in a patient with Wolf-Parkinson-White syndrome
Published in Baylor University Medical Center Proceedings, 2018
Keith Suarez, Javier E. Banchs, Judith P. Lazol, James N. Black
The coronary sinus (CS) drains most of the venous blood from the heart. Many of its anatomical variants have been described, and some of them have implications for procedures like cardiac resynchronization therapy, heart surgery, mapping and ablation of accessory pathways, and ventricular tachycardias. The great cardiac vein (GCV) and middle cardiac vein are tributaries to the CS and have been shown in imaging and autopsy studies to be very consistent morphologically. We present a patient with a GCV that drained separately from the CS into the right atrium that was found incidentally during mapping and ablation of an accessory pathway.
Appropriate use criteria of left atrial appendage closure devices: latest evidences
Published in Expert Review of Medical Devices, 2023
Fabrizio Guarracini, Eleonora Bonvicini, Alberto Preda, Marta Martin, Simone Muraglia, Giulia Casagranda, Marianna Mochen, Alessio Coser, Silvia Quintarelli, Stefano Branzoli, Roberto Bonmassari, Massimiliano Marini, Patrizio Mazzone
Left atrial appendage has a high variability in its size, shape, and spatial relation with the surrounding structures [41]. It derives from the primordial left atrium, emerging from the margin between the anterior and the lateral LA walls with a small orifice, followed by a narrow neck that unfolds with different curvatures in the body of the appendage. It has anatomical relations with vital organs, like the left circumflex artery and the great cardiac vein