Anatomical Study of the Cardiac Veins and their Tributaries in Bovines (Bos indicus) in Comparison with Humans and Other Animal Species / Estudio Anatómico de las Venas Cardiacas y sus Tributarias en Bovinos (Bos indicus) en Comparación con Humanos y Otras Especies Animales

SUMMARY: In bovines, anatomical observations of the coronary vascular tree describe qualitative characteristics. The objective of this study was to morphometrically characterize the coronary veins and their tributaries in cattle. An arcuate application with 2.0 silk was performed around the ostium of the coronary sinus of 28 bovine hearts and a number 14 catheter was placed, through which semi- synthetic polyester resin and mineral blue color was perfused. In 22 hearts (78.6 %) the great cardiac vein was originated at the cardiac apex. The configuration of the arteriovenous trigone was mainly closed inferior and superior types (50 %). The caliber of the great cardiac vein at the level of the atrioventricular sulcus was 6.7 +/- 1.2 mm. The origin of the left marginal vein was observed in the lower third of the left cardiac margin (53.6 %), its distal caliber was 4.1 +/- 0.8 mm and its drainage was at the level of the great cardiac vein. The middle cardiac vein originated from the cardiac apex in 78.6 % of the samples, emptied mainly into the coronary sinus (82.1 %) and its distal caliber was 4.7 +/- 0.9 mm. Anastomoses occurred in 28.6 % of the hearts, being found in most cases between the middle cardiac vein and the great cardiac vein (50 %), which was significant compared to other anastomoses (p<0.001). The length of the coronary sinus was 42.2 +/- 5.1 mm, its distal caliber was 13.8 +/- 2 mm, and its shape was cylindrical. Myocardial bridges were found in 3 hearts (10.7 %) mainly in the lower third of the middle cardiac vein (66.6 %). Most of the main coronary veins drained into the coronary sinus, with some cases with atypical outlets and the presence of a high percentage of anastomosis that serves to improve cardiac venous drainage in case of venous compression or obstruction.

En bovinos, las observaciones anatómicas de árbol vascular coronario describen características cualitativas. El objetivo de este estudio fue caracterizar morfométricamente las venas coronarias y sus tributarias en bovinos. Se realizó una aplicatura arciforme con seda 2.0 alrededor del ostium del seno coronario de 28 corazones de bovino y se colocó un catéter número 14, a través del cual se perfundió resina de poliéster semisintética y color azul mineral. La vena cardiaca magna se originó en 22 corazones (78,6 %) en el ápex cardiaco. La configuración del trígono arteriovenoso fue principalmente cerrado inferior y superior (50 %). El calibre de la vena cardiaca magna a nivel del surco atrioventricular fue 6,7 +/- 1,2 mm. El origen de la vena marginal izquierda se observó en el tercio inferior del margen izquierdo cardiaco (53,6 %), su calibre distal fue 4,1 +/- 0,8 mm y su desembocadura fue a nivel de la vena cardiaca magna. La vena cardiaca media se originó en el ápex cardiaco en el 78,6 % de las muestras, desembocó principalmente en el seno coronario (82.1 %) y su calibre distal fue 4,7 +/- 0,9 mm. Se presentó anastomosis en el 28,6 % de los corazones, encontrándose en la mayoría de los casos entre la vena cardiaca media y la vena cardiaca magna (50 %), lo cual fue significativo en comparación con otras anastomosis (p<0,001). La longitud del seno coronario fue 42,2 +/- 5,1 mm, su calibre distal fue 13,8 +/- 2 mm y su forma fue cilíndrica. Se encontró puentes miocárdicos en 3 corazones (10,7 %) y en el tercio inferior de la vena cardiaca media (66,6 %). La mayoría de las venas coronarias principales desembocan en el seno coronario, con algunos casos con desembocaduras atípicas y la presencia de un alto porcentaje de anastomosis que sirve para mejorar el drenaje venoso cardiaco en caso de compresión u obstrucción venosa.

Coronary venous anatomy relevant to cardiac resynchronization therapyan angiographic study

Cardiac resynchronization therapy (CRT) in-volves placing a lead through the coronary sinus to pace the left ventricle. However, technical problems arise in the procedure either due to variant anatomy or due to the presence of valves. Information on coronary venous anatomy is scarce in the South Indian population. The aim of this study was to describe the coronary sinus anatomy in patients undergoing CRT implant. Coronary sinus angiograms were used to study the following parameters: (a) Dimensions of coronary sinus (b) Number and distribution of tributaries (excluding middle and great cardiac veins) (c) Diameter of major veins at the origin (d) Angulation of tributaries with CS. Measurements were made using calipers in the dicom viewer. Out of the 24 angiograms studied, only a single tributary of adequate size was noted in 70.8% (17/24) of the cases, which was most commonly a midlateral vein (76.5%). Two prominent tributaries were noted in 29.2% (7/24) of cases. The average diameter of the veins was 3.93 mm and 80.6% of the veins had an obtuse angle of drainage. Anatomical variations in the coronary venous systemin this population suggest that the majority of patients have a single suitable tributary and this is most often the midlateral vein, which is known to have the most favorable outcome. Data obtained in this study will guide clinicians in left ventricular lead placement in the South Indian population leading to greater procedural success

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An anatomical investigation of the coronary ostia and its relationship to the sinotubular junction within a select South African population

The coronary ostia (CO) lie within the left and right aortic sinuses, respectively; and are bound by the sinotubular junction (STJ) superiorly. The high frequency of cardiac procedures that require catheterization has necessitated the reappraisal of the anatomy of the origin of the coronary arteries. Therefore, this study aimed to describe the CO by recording its diameter, shape, and relation to the sinotubular junction in a select South African population.The present study included the gross dissection of 50 formalin fixed, adult cadaveric hearts. The average diameter of the right coronary ostium (RCO) was 3.29mm and the left coronary ostium (LCO) was 3.87mm. With regard to the shape of the ostia, the RCO was described as circular in 52% (26/50), horizontally ellipsoid in 24% (12/50) and vertically ellipsoid in 24% (12/50) of cases. The LCO was circular in 30% (15/50), horizontally ellipsoid in 60% (30/50) and vertically ellipsoid in 10% (5/50) of cases. The RCO was located below the STJ in 88% (44/50) and at the level of the STJ in 12% (6/50) of cases. The LCO was recorded below the STJ in 64% (32/50), at the level of the STJ in 32% (16/50) and above the STJ in 4% (2/50) of cases. Multiple ostia arising from a single aortic sinus was recorded in 14% (7/50) of cases. In 2% (1/50) of cases, the RCO was located in the non-coronary sinus. In addition, the RCO arose from the left aortic sinus in 2% of cases. The results of the present study correlate with those of previous studies. Anomalous CO, although asymptomatic has been linked to myocardial infarction and sudden cardiac death. It is, therefore, imperative for the clinician to be aware of variant CO anatomy, which may alert them to the predisposition of cardiac risks

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Morphological expression of the pig coronary sinus and its tributaries: a comparative analysis with the human heart

The objective of this study was to determine the morphological expression of the coronary sinus and its tributary branches in pigs. This descriptive cross-over study evaluated continuous variables with t test, and discrete variables with the Pearson χ square test. A level of significance p <0.05 was used. The coronary sinus (CS) and its tributaries were perfused with polyester resin (Palatal 85%, Styrene 15%), and then the hearts were subjected to KOH infusion to release subepicardal fat. The shape, trajectory and morphometry of the CS and its tributary veins were assessed. The CS was 26.9 ± 5.69 mm in length, with a proximal caliber of 10.8 ± 2.43 mm. It was cylindrical in shape in 69% of cases. The left marginal had a distal caliber of 2.6 ± 0.75 mm. The distal caliber of the middle cardiac vein (MCV) was 3.7 ± 1.04 mm. An anastomosis between the venous branches was observed in 63% of hearts. The caliber of the minor cardiac vein and the left azygous vein was 1.67 ± 0.49 mm and 8.47 ± 2.07, mm respectively. The distal caliber of the right marginal vein was 1.54 ± 0.28 mm. Myocardial bridges over the MCV were found in 10 cases (8%). A greater frequency of anastomoses was observed at the level of the heart apex between the MCV and the great cardiac vein than described in human studies. Because human and swine hearts exhibit similarity in the pattern of the CS and its tributaries, this animal model is suitable for performing procedural and hemodynamic applications

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Topography, morphology and morphometry of coronary ostia - a cadaveric study

The right and left coronary ostia are located in relation with the sinus of Valsalva. The coronary ostia are located close to the aortic root, which is an important area for interventional cardiologists and radiologists. This study encompasses the topography, morphology and morphometry of the coronary Ostia. 90 cadaver heart specimens fixed in 10% formalin were dissected. Shape and location of the coronary ostia was determined. The diameter of the ostium and distance from the base of the cusp up to the ostium was measured with the help of a measuring scale. 76.6% of Right coronary ostia (RCO) and 73.3% of Left coronary ostia (LCO) were horizontally oval in shape. 16% of RCO and 23% LCO were circular and 7% of RCO and 10% of LCO were vertically oval in shape. The mean diameter of RCO & LCO was 2.5±1 mm and 2.8±1 mm respectively. 56.6% of Right coronary ostia and 52.2% of Left coronary ostia were located in the central (middle 1/3rd) position of the cusp. The ostia were located at a distance of 5-18 mm from the base of the cusp. The average diameter was 2.5 mm. The most common location was sinotubular and central, and the most common shape was horizontally oval. Occasionally, more than one ostium was seen in the right coronary sinus. Study of the topography, morphology and morphometry of coronary ostia is essential for cardiac interventional procedures done for diagnostic and therapeutic purposes

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Morfologia do seio coronário em fetos de bovinos azebuados / Morphology of coronary sinus in bovine fetal hearts

O seio coronário em fetos de bovinos azebuados é estudado através de dissecções e radiografias vasculares. Há dois padrões predominantes de formação: por continuação direta da veia ázigos esquerda, a partir da veia cardíaca magna; e pela união da veia cardíaca magna com a veia ázigos esquerda. O primeiro padrão de formação do seio coronário apareceu em 17 animais, enquanto o segundo padrão foi encontrado em 13 animais. Quanto ao sexo, não houve diferença entre os padrões apresentados. Os principais tributários venosos do seio coronário em fetos de bovinos são representados pelos seguintes vasos: veia cardíaca magna, veia cardíaca média, veias da face atrial do ventrículo esquerdo e, veias oblíquas do átrio esquerdo. A veia cardíaca magna é observada como uma continuação direta da veia interventricular paraconal. A partir destes resultados, constata-se que o padrão venoso cardíaco no feto bovino é predominantemente confluente ao seio coronário. Apenas um pequeno número de vasos é diretamente confluente ao átrio direito do coração bovino.

The coronary sinusin fetuses ofzebu-crossedbovinesis studiedbyvasculardissectionsand radiographs. There aretwopredominant patterns offormation of thecoronary sinus: bydirect continuation of theleft azygos vein, from thegreat cardiac vein, and by theunion of thegreat cardiac veinwith theleft azygos vein. The first patternappeared in17animals,while thesecondpatternformation of thecoronary sinuswas found in13animals. Regarding sex there was nodifference between thepatterns shown.The main tributariesof the coronaryveinincattleare representedby the followingvessels: great cardiac vein, middle cardiac vein, veins of the faceof theleft ventricle andatrium, obliqueveinof left atrium.The great cardiac veinisseen asadirect continuation of theinterventricular veinparaconal. From these results, it appears thatthe standardvenousfetalbovineheartis predominantlyconfluentthe coronary sinus. Onlyasmall number ofvesselsare directlyconfluentto theright atrium ofbovine heart.

Atresia of the coronary sinus ostium to the right atrium with a persistent left superior vena cava / Atresia del ostium del seno coronario en el atrio derecho con una vena cava superior izquierda persistente

The coronary sinus has lately assumed an important role in the cardiologic clinic once it has been widely used in invasive procedures of the heart. Commonly, it is used during the electrodes implants for the epimiocardic monitoring of the cardiac rhythm, through a biventricular pace maker. These invasive procedures are not possible in hearts with an atresic coronary sinus ostium. In the presence of this anomaly, another may occur: the development of the "Marchal" vein which is a remaining of the left superior vena cava (LSVC). This happens so that the venous blood from the heart can drain into the right atrium, by a communication between the LSVC and the left brachiocephalic vein. The presence of a LSVC brings difficulties when performing an invasive procedure in order to access the right atrium through the superior vena cava, usually done in the cardiologic clinic. Moreover, the LSVC crossing over the left atrium is vulnerable to cardiovascular surgical interventions, confirmed by clinical reports. In the present study, 400 formalin fixed hearts from male cadavers, aged between 35 and 80 years, were investigated, particularly for the anatomy of the coronary sinus. The obliterated ostium of the coronary sinus to the right atrium associated with a persistent LSVC was present in only one (0.25 percent). We performed a diameter study of these structures since they were dilated due to the venous blood from the heart draining into the right atrium, by a communication between the LSVC and the left brachiocephalic vein. We also perform a literature review of these cases and discuss our finding in relation to its clinical importance.

El seno coronario recientemente ha asumido un papel importante en la clínica cardiológico, siendo ampliamente utilizado en procedimientos invasivos del corazón. Comúnmente, se utiliza en los implantes de los electrodos para el monitoreo epimiocárdico del ritmo cardiaco, a través de un ritmo biventricular establecido. Estos procedimientos invasivos no son posibles en los corazones con una atresia del ostium del seno coronario. En presencia de esta condición, se puede producir otra anomalía: el desarrollo de la vena de "Marchal" la cual es un vestigio de la vena cava superior izquierda (VCSI). Esto provoca que la sangre venosa del corazón pueda drenar en el atrio derecho, por una comunicación entre la VCSI y la vena braquicefálica izquierda. La presencia de una VCSI trae dificultades a la hora de realizar un procedimiento invasivo con el fin de acceder al atrio derecho a través de la vena cava superior, usualmente hecho en la clínica cardiológica. Por otra parte, el cruzamiento de la VCSI sobre el atrio izquierdo es vulnerable en las intervenciones quirúrgicas cardiovasculares, confirmado por informes clínicos. En el presente estudio, 400 corazones fijados en formalina provenientes a cadáveres de sexo masculino, con edades comprendidas entre los 35 y 80 años, fueron investigados, en particular por la anatomía del seno coronario. El ostium obliterado del seno coronario al atrio derecho asociado con una VCSI persistente estuvo presente en sólo una muestra (0,25 por ciento). Se realizó un estudio del diámetro de estas estructuras dilatadas debido a que la sangre venosa drena desde el corazón hacia el atrio derecho, por una comunicación entre la VCSI y la vena braquicefálica izquierda. También se realiza una revisión de la literatura de estos casos y se discuten nuestros hallazgos en relación con su importancia clínica.