Humans ; Sinus of Valsalva ; Death, Sudden, Cardiac/etiology* ; Coronary Stenosis/complications*

coronary artery from the left coronary sinus (R-ACAOS) with an interarterial course, assess the relationship of CT-FFR with the anatomical features of interarterial R-ACAOS on coronary computed tomographic angiography (CCTA), and determine its clinical relevance.MATERIALS AND METHODS: Ninety-four patients with interarterial R-ACAOS undergoing CCTA were retrospectively included. Anatomic features (proximal vessel morphology [oval or slit-like], take-off angle, take-off level [below or above the pulmonary valve], take-off type, intramural course, % proximal narrowing area, length of narrowing, minimum luminal area [MLA] at systole and diastole, and vessel compression index) on CCTA associated with CT-FFR ≤ 0.80 were analyzed. Receiver operating characteristic analysis was performed to describe the diagnostic performance of CT-FFR ≤ 0.80 in detecting interarterial R-ACAOS.RESULTS: Significant differences were found in proximal vessel morphology, take-off level, intramural course, % proximal narrowing area, and MLA at diastole (all p < 0.05) between the normal and abnormal CT-FFR groups. Take-off level, intramural course, and slit-like ostium (all p < 0.05) predicted hemodynamic abnormality (CT-FFR ≤ 0.80) with accuracies of 0.69, 0.71, and 0.81, respectively. Patients with CT-FFR ≤ 0.80 had a higher prevalence of typical angina (29.4% vs. 7.8%, p = 0.025) and atypical angina (29.4% vs. 6.5%, p = 0.016).CONCLUSION: Take-off level, intramural course, and slit-like ostium were the main predictors of abnormal CT-FFR values. Importantly, patients with abnormal CT-FFR values showed a higher prevalence of typical angina and atypical angina, indicating that CT-FFR is a potential tool to gauge the clinical relevance in patients with interarterial R-ACAOS.]]>
Angiography ; Coronary Sinus ; Coronary Vessel Anomalies ; Coronary Vessels ; Diastole ; Hemodynamics ; Humans ; Phenobarbital ; Prevalence ; Retrospective Studies ; ROC Curve ; Systole

Unroofed coronary sinus syndrome (UCSS), also named coronary sinus septal defect, is a rare type of atrial septal defect with the incidence less than 1% of the total number of atrial septal defects. It is caused by incomplete formation of left atrial venous folds during embryonic development. Here we reported a patient with UCSS, who was treated in the Second Xiangya Hospital of Central South University. The patient was 50 years old and the main clinical manifestations were fatigue and shortness of breath after repeated exercise. Color Doppler echocardiography showed coronary sinus dilatation (17 mm×14 mm), indicating the possibility of permanent left superior vena cava. Pulmonary angiography showed that the left ventricle and coronary sinus were developed at the same time while the atrial septum was intact after the development of the left atrium, followed by the right atrium and right ventricle, indicating a partial anomalous pulmonary venous drainage (intracardiac type). Finally, the cardiac computed tomograhic angiography showed that 4 pulmonary veins and permanent left superior vena cava (PLSVC) went into the left atrium and the coronary sinus, respectively, while the coronary sinus septum was absent and the PLSVC was connected with the left atrium. The patient was later treated with the correction of non-parietal sinus syndrome in the Cardiovascular Surgery Department of our hospital.
Coronary Sinus ; Heart Atria ; Heart Septal Defects, Atrial ; Humans ; Middle Aged ; Vena Cava, Superior

Polyurethane foam (PU foam) is a new material which is being used in producing both macro-anatomical and micro-anatomical specimens. PU foam is simple to use, without need for special equipment. The present study was carried out to evaluate morphology of coronary sinus and its tributaries. During the study, we encountered few problems in carrying out injections. Coronary sinus and its tributaries were difficult to cannulate since the coronary sinus lacks a vascular stem, around which ligature can be tied before injection so that the cannula can be held in place. In contrast, in majority of the organs it is easy to inject since they possess tubular vascular stem to hold the cannula in place. A new device was developed which could be used to cannulate coronary sinus orifice to inject the casting media. The second problem we faced was saponification of adipose tissue. This made corrosion of the soft tissue difficult. Hence in this study, we describe the device we have developed to place in the coronary sinus orifice, and how saponified adipose tissue was taken care during the actual maceration step.
Adipose Tissue ; Catheters ; Coronary Sinus ; Coronary Vessels ; Corrosion ; Ligation ; Methods ; Polyurethanes

We present a unique, unreported variation of the left coronary artery. During dissection classes for first-year medical students, we observed the absence of left coronary artery in an adult male cadaver aged approximately 78 years. The left aortic sinus was dilated and it gave origin to anterior interventricular and left marginal arteries independently. Left marginal artery was large and the circumflex artery arose from it. There were two independent opening for anterior interventricular and left marginal arteries in the left posterior aortic sinus. No variations were found in the origin and branching pattern of right coronary artery and the walls and chambers of the heart.
Adult ; Aorta ; Arteries ; Cadaver ; Coronary Vessels ; Heart ; Humans ; Male ; Sinus of Valsalva ; Students, Medical

Inter atrial block (IAB) is a prevailing cardiac conduction abnormality that is under-recognized in clinical practice. IAB has strong association with atrial arrhythmia, left atrial enlargement, and electromechanical discordance, increasing the risk of atrial fibrillation (AF) and myocardial ischemia. IAB was generally believed to be caused by impaired conduction along the Bachmann bundle (BB). However, there are three other conduction pathways, including the fibers posteriorly in the vicinity of the right pulmonary veins (VRPV), transseptal fibers in the fossa ovalis (FO), and muscular bundles on the inferior atrial surface near the coronary sinus (CS). We hypothesized that the importance of BB on IAB might have been overestimated. To test this hypothesis, various combinations of conduction pathway blocks were simulated based on a realistic human atrial model to investigate their effects on the index of clinical diagnosis standard of IAB using a simulated 12-lead electrocardiogram (ECG). Firstly, the results showed that the BB block alone could not generate typical P wave morphology of IAB, and that the combination of BB and VRPV pathway block played important roles in the occurrence of IAB. Secondly, although single FO and CS pathways play subordinate roles in inter atrial conduction, their combination with BB and VRPV block could also produce severe IAB. In summary, this simulation study has demonstrated that the combinations of different inter atrial conduction pathways, rather than BB alone, resulted in ECG morphology of IAB. Attention needs to be paid to this in future pathophysiological and clinical studies of IAB.
Adult ; Arrhythmias, Cardiac/physiopathology* ; Atrial Fibrillation/physiopathology* ; Computer Simulation ; Coronary Sinus/physiopathology* ; Electrocardiography ; Heart ; Heart Atria ; Humans ; Male ; Models, Anatomic ; Models, Cardiovascular ; Pulmonary Veins/physiopathology*

The objective of this case report is to alert the cardiologists and radiologists about the possibility of an extremely rare trifurcation of the right coronary artery. During dissection classes, an early trifurcation of the right coronary artery (RCA) was observed in an adult male cadaver aged approximately 65 years. The RCA had a normal origin from the anterior aortic sinus. After a course of just 2 mm, it trifurcated into a conus artery, a huge right ventricular branch and then a main continuation of the RCA. The conus artery entered the myocardium of the conus after a short course. The huge ventricular branch had a downward and left course almost till the apex of the heart. Right marginal artery was absent. No other vascular variations of heart were observed apart from this. Knowledge of this trifurcation could be useful in coronary angioplasty and bypass procedures.
Adult ; Angioplasty ; Arteries ; Cadaver ; Conus Snail ; Coronary Vessels* ; Heart ; Humans ; Male ; Myocardium ; Sinus of Valsalva

Angiography ; Computed Tomography Angiography ; Coronary Angiography ; Coronary Sinus ; diagnostic imaging ; pathology ; Coronary Vessel Anomalies ; diagnostic imaging ; Humans ; Vena Cava, Superior

No abstract available.
Coronary Sinus ; Heart Septal Defects, Atrial

It is estimated that 15% of traffic accidents cause trauma to large vessels. In about 70%-95% of cases, aortic rupture took place in the distal ligament of the left subclavian artery, whereas in the remaining cases rupture occurred in the ascending aorta above the aortic valve. Trauma to the aortic sinus and coronary arteries is rarely found in traffic accident victims. Therefore, coronary artery trauma is often misdiagnosed as coronary atherosclerotic heart disease. The present case is a 42 years old male who survived from a traffic accident. He presented with aortic sinus and left coronary artery trauma. He was misdiagnosed as having coronary atherosclerotic heart disease, and therefore wrongly given antiplatelet medicine, such as aspirin, in another hospital. Definite diagnosis was achieved in our hospital, and the patient underwent Bentall and mitral valve replacement, as well as tricuspid valvuloplasty. The aortic occlusion time during surgery was 47 min, and the total cardiopulmonary bypass time was 63 min. After surgery, transthoracic echocardiography confirmed that all the artificial valves worked sufficiently. The patient felt good and symptoms such as asthma and decreased exercise tolerance disappeared. This case taught us that acute aortic syndrome cannot be ignored when patients present with pectoralgia; antiplatelet medication should not be given before definite diagnosis.
Adult ; Coronary Artery Disease ; diagnosis ; Coronary Vessels ; injuries ; Diagnostic Errors ; Humans ; Male ; Sinus of Valsalva ; injuries