Persistent left superior vena cava
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček in Congenital Heart Disease in Adults, 2008
A persistent left superior vena cava can be demonstrated by echocardiography, preferably by transesophageal echocardiography, visualizing it laterally to the left atrium in the transverse projection. The course and entry of the persistent left-side superior vena cava is evident in the longitudinal projection. Preoperative detection and description of a persistent left superior vena cava are crucial if a patient with either acquired or congenital heart disease is undergoing cardiovascular surgery. In the differential diagnosis, a dilated coronary sinus can be seen in elevated right atrial pressure of any cause, e.g. significant tricuspid regurgitation. Contrast echocardiography will reveal contrast medium regurgitating from the right atrium into the coronary sinus, but not contrast coming from inside the coronary sinus. On cursory examination, a significantly dilated coronary sinus may be mistaken for ostium primum atrial septal defect.
Conduction of electrical activity in the heart
Burt B. Hamrell in Cardiovascular Physiology, 2018
Ions move freely from myocyte to myocyte through gap junctions. Electrical charges carried by ions easily move from cardiac muscle cell to cardiac muscle cell and throughout normal heart muscle tissue. The electrical response of heart muscle is all or none, which means that an adequate stimulus to one healthy atrial myocyte will result in an action potential that is then transmitted to all the other atrial myocytes. Each myocyte is a separate cell with its own cell machinery and bounded by a membrane, the sarcolemma. But the low myocyte-to-myocyte electrical resistance at the gap junctions and easy myocyte-to-myocyte transmission of action potentials result in the heart behaving as if it were a syncytium. Electrical activity is conducted from atrial myocyte to atrial myocyte throughout the right and left atria primarily via gap junctions. The Atrioventricular node is in the right atrium at the bottom of the interatrial septum near the opening of the coronary sinus.
Autopsy Cardiac Examination
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
The excised heart displayed grossly, recorded photographically, measured carefully and studied histologically remains the gold standard against which antemortem clinical findings are measured. Exact measurements are needed to confirm cardiac atrial dilatation, ventricular hypertrophy or dilatation, critical valve stenosis, valve regurgitation and aortic dilatation, as well as coronary artery narrowing. The epicardial surface of the heart normally contains fat. There are two major coronary arterial branches which arise from two of the three sinuses of Valsalva: the right coronary and left coronary sinuses respectively. The two coronary arteries have major differences in their branching patterns once they emerge from their sinuses. 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.
Operative approach for right coronary artery to coronary sinus fistula
Published in Baylor University Medical Center Proceedings, 2020
Jonathan Liu, Subbareddy Konda
Coronary artery fistula is a rare congenital heart disease that is defined as an abnormal connection between a coronary artery and a cardiac vessel or cardiac chamber. Most coronary artery fistulas involve the right coronary artery draining into the right-sided heart structures. We present a patient with right coronary artery to coronary sinus fistula diagnosed by coronary angiography. The surgical approach of retrograde cardioplegia and transatrial resection allowed for protection of the myocardium and definitive visualization and closure of the abnormal fistula.
The coronary sinus reducer: clinical evidence and technical aspects
Published in Expert Review of Cardiovascular Therapy, 2017
Francesco Giannini, Andrea Aurelio, Richard J. Jabbour, Luca Ferri, Antonio Colombo, Azeem Latib
Introduction: Chronic refractory angina is often a disabling condition, predominantly due to severe obstructive coronary artery disease, that is inadequately controlled by optimal medical therapy and not amenable to further percutaneous or surgical revascularization. mortality rates associated with this condition are relatively low in clinically stable patients. however, it is associated with a high hospitalization rate and a reduction in both exercise capacity and quality of life. due to the paucity of available treatment options, there is an unmet need for new therapies for these patients and for a reduction in the associated economic healthcare burden. Areas covered: This review is focusing on the clinical evidence and technical aspects of this new therapeutic modality in refractory angina patients unsuitable for revascularization. Expert commentary: The Coronary Sinus Reducer (Neovasc Inc. Richmond B.C., Canada) is a new percutaneous device designed to achieve a controlled narrowing of the coronary sinus that may alleviate myocardial ischemia, possibly by redistributing blood from the less ischemic sub-epicardium to the more ischemic sub-endocardium, or by neoangiogenesis. Recently, a randomized, double-blind, multi-center clinical trial demonstrated a benefit in improving symptoms in 104 refractory angina patients, when compared to placebo.
Fatal multiple coronary involvements in a young woman with systemic lupus erythematosus
Published in Acta Clinica Belgica, 2014
N. Ha Vu, R. Duttmann, D. De Bels, J. Devriendt, P. Reper
We report a rare case of fulminant congestive heart failure with fatal outcome in a 21-year-old girl with systemic lupus erythematosus (SLE). A young woman was admitted in the intensive care unit for pericardial tamponade associated with disseminated coagulopathy and refractory shock secondary to multiple coronary aneurysms. Post-mortem examination revealed significant multiple coronary lesions with aneurysms of the interventricular and right coronary arteries, responsible of muscular necrosis, thrombosis of the coronary sinus, and significant pericardial infiltration with hemorrhagic fluid. We describe a refractory cardiac failure with extensive coronary artery involvements, which is very uncommon in young patients with SLE: few cases have been previously described in the literature. We report a rare case of fulminant congestive heart failure with fatal outcome in a young woman with SLE related to extensive coronary involvements.
Related Knowledge Centers
- Right Atrium
- Vein
- Heart
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- Left Atrium
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