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PubMed2005

Inability to cannulate the coronary sinus in patients with supraventricular arrhythmias: congenital and acquired coronary sinus atresia.

We report 4 cases of congenital and acquired coronary sinus ostial atresia incidentally found during electrophysiologic assessment for supraventricular arrhythmias. Congenital variants consisted of coronary sinus drainage predominantly via persistent left superior vena cavae and partial coronary sinus unroofing into the left atrium. The acquired variant was inadvertently produced during surgery for cor triatriatum. A variety of electrophysiologic substrates including right and left-sided accessory pathways and both typical and atypical AV nodal reciprocating tachycardia were identified. Approaches to imaging and accessing the coronary sinus when the os cannot be cannulated are discussed, including a search for right atrial accessory venous collaterals, venography to rule-out a persistent left superior vena cava, and coronary angiography.

Adolescent↗
PubMed1992

Atrial parasystolic trigeminy with sinus node echoes during wandering sinus node pacemaker in a patient with malignant lymphoma and hypertrophic cardiomyopathy.

A case of atrial parasystolic trigeminy associated with shifting or wandering pacemaker in a patient with malignant lymphoma and hypertrophic cardiomyopathy is presented, in which concomitant unsustained sinus node echoes during flattening of sinus P wave were observed. This is the first report to prove that wandering sinus pacemaker was one of the causes of sinus echoes.

Aged↗
PubMed1999

Complete unilateral anomalous connection of the left pulmonary veins to the coronary sinus with unroofed coronary sinus syndrome: a case report.

We report a case of complete unilateral anomalous connection of the left pulmonary veins to the coronary sinus with unroofed coronary sinus syndrome. Magnetic resonance imaging (MRI) was a useful diagnostic method in our case. At operation, a cut was made from the orifice of the coronary sinus to the unroofed portion of the coronary sinus, and part of the lower atrial septum was excised. The resulting defect was closed with a Dacron patch, diverting the left pulmonary venous blood into the left atrium.

Adult↗
PubMed1982

Electrophysiological effects of glucose-insulin-potassium on sinus node function in patients with and without sinus node dysfunction.

The electrophysiological effects of glucose (100 g)-insulin (20 U)-potassium (10 mmol X litre-1) infusion (GIK) on three parameters of sinus node function were studied in 14 control subjects (mean age 53 +/- 14 yr) and 11 patients (mean age 50 +/- 17 yr) with sinus node dysfunction (SND). In a first series of experiments the response to GIK was examined in nine control and 11 SND patients. Following GIK, the mean spontaneous cycle length decreased by 17% (671 to 560 ms; P less than 0.01) in the control group and by 33% (1066 to 715 ms; P less than 0.001) in the SND patients; this difference between both groups was statistically significant (P less than 0.01). In the control group mean corrected sinus node recovery time (CRST) and calculated sinoatrial conduction time (SACT; n = 6) were not significantly altered after GIK. In SND patients GIK decreased the mean value of CSRT by 40% (693 to 416 ms; P less than 0.05) and of calculated SACT (n = 6) by 27% (130 to 95 ms; P less than 0.05); prolonged secondary pauses following termination of rapid atrial pacing in SND patients were also shortened. In a second series of experiments, mannitol (100 g, iv) was administered in five control patients but had no significant effect on the electrophysiological parameters tested. Plasma levels of glucose were significantly increased, by 500% (P less than 0.01), after GIK; plasma potassium and sodium concentrations decreased by 7 and 5% (P less than 0.05). The results indicate that GIK had a beneficial effect on sinus node dysfunction.

Adult↗
PubMed1991

Coronary sinus blood flow and coronary haemodynamic function in children: measurement by the continuous thermodilution method with coronary sinus cannulation via the femoral vein.

In 19 children with Kawasaki disease without any cardiac sequelae the coronary sinus was cannulated via the femoral vein with a specially designed flow catheter and coronary sinus blood flow was measured by the continuous thermodilution method. There was a statistically significant positive correlation between coronary sinus blood flow and age, body surface area, and left ventricular mass, but coronary sinus blood flow per left ventricular mass (100 g) was negatively correlated with age, body surface area, and left ventricular mass. Coronary vascular resistance was negatively correlated with age, body surface area, and left ventricular mass. Younger children require a much greater coronary blood flow per left ventricular mass and have a higher coronary vascular resistance than older children and adolescents. These results may indicate that coronary blood flow is less efficient in childhood than in adolescence or adulthood.

Adolescent↗
PubMed1993

MR imaging of the tarsal sinus and canal: normal anatomy, pathologic findings, and features of the sinus tarsi syndrome.

After definition of the normal anatomic features of the tarsal sinus and canal at magnetic resonance (MR) imaging, 123 ankle MR imaging studies in 116 patients were reviewed. Abnormalities of the tarsal sinus and canal were seen on MR images in 33 cases (26.8%), were highly associated with tears of the lateral collateral ligament, and could be categorized according to the pathologic findings in patients with sinus tarsi syndrome: (a) diffuse infiltration with low T1- and T2-weighted signal intensity (n = 17) consistent with fibrosis, (b) diffuse infiltration with low T1-weighted signal intensity and increased T2-weighted signal intensity (n = 11) consistent with chronic synovitis and nonspecific inflammatory changes, and (c) multiple abnormal fluid collections (n = 5) consistent with synovial cysts. Absence of the anterior microrecesses of the posterior subtalar joint was a common finding on normal MR imaging studies (46 of 90) and may reflect lack of iatrogenic joint distention. Tears of the posterior tibial tendon may have a previously unrecognized association with the sinus tarsi syndrome.

Adult↗
PubMed1981

Bimodal relationship between sinus node arterial distension and sinus nodal automaticity.

In the isolated buffer perfused canine sinus node the effect of either an increase or decrease in perfusion rate (PR), and hence sinus node (SN) arterial pressure (PSNA), on the frequency of sinus nodal depolarization (SDF) is bimodal. SDF decreased from 121.9 +/- 6.1 to 101.4 +/- 6.0 depolarizations/min as PR and PSNA increased from 1 to 4 ml/min and from 18.7 +/- 3.8 to 45.1 +/- 7.3 mmHg, respectively. Further increasing PR from 4 to 10 ml/mn (PSNA increasing from 45.1 +/- 7.3 to 94.0 +/- 14.1 mmHg) caused SDF to increase from 101.4 +/- 6.0 to 121.0 +/- 7.4 depolarizations/min. With respect to the PR, SDF is logarithmically related to the relative degree to which the SN artery is distended, the degree of SN arterial distension being determined by the change in SN arterial resistance (R) with respect to PR (dR/dPR). This relationship is defined by the equation: SDF = 9.23 1n(--dR/dPR) + 99.7. While these results support the existence of a mechanism for autoregulation of sinus nodal automaticity, they indicate that it is considerably more complex than previously envisioned.

Animals↗
PubMed1978

Coronary sinus reflux. A source of error in the measurement of thermodilution coronary sinus flow.

In seven patients thermodilution coronary sinus flow (TD-CSF) was higher (164 +/- 21 ml/min) during ventricular pacing than during atrial pacing (119 +/- 21 ml/min, P less than 0.005) at identical heart rate, without an increase in the determinants of myocardial oxygen consumption. To assess the possibility of right atrial admixture in coronary sinus blood during ventricular pacing we compared electromagnetic coronary arterial blood flow (CBF) with TD-CSF in nine dogs during interventions that increased right atrial pressure. During ventricular pacing, rapid atrial pacing, pulmonary artery constriction and increased intrathoracic pressure, right atrial pressure increased and electromagnetic CBF was significantly less (41-166%) than TD-CSF. Marked reflux from the right atrium to the coronary sinus was also demonstrated by bolus injection of cold saline into the right atrium and continuous infusion of contrast material into coronary sinus. Caution needs to be exercised in interpreting TD-CSF in the presence of changing right atrial pressure.

Adult↗
PubMedDate not supplied

Sinus node dysfunction in a heart transplant patient secondary to severe sinus node artery obstruction--a case report.

A case of sinus node dysfunction is reported secondary to severe sinus node artery obstruction 3 years after orthotopic heart transplantation. The patient first presented with frequent dizzy spells and presyncopal episodes for 3 months and then recurrent syncope in the presence of an acute myocardial infarction. Coronary angiography showed a diffusely narrowed sinus node artery without any apparent collateral vessels. The sinus node artery had had only minimal distal disease 3 months previously. A dual chamber permanent pacemaker was implanted with significant improvement in clinical symptoms.

Arterial Occlusive Diseases↗
PubMed1992

The effect of intermittent coronary sinus occlusion on coronary sinus pressure dynamics and coronary arterial flow.

The effect of intermittent coronary sinus occlusion (ICSO) with a balloon-tipped catheter on coronary arterial flow and coronary sinus pressure (CSP) dynamics were studied in open-chest dogs. During coronary sinus occlusion (CSO), CSP gradually rose and finally reached a plateau, while left coronary arterial mean flow velocities decreased. After the release of CSO, CSP immediately returned to baseline values, and the flow velocities correspondingly increased over the baseline values (hyperemic response). The decrease in ratios of flow velocities during CSO were unrelated to the duration of CSO, whereas hyperemic responses were positively correlated with the CSO duration. In the repetitive application of CSO (ICSO), inadequately short duration of release period decreased the net volume of coronary arterial flow significantly. Moreover, hyperemic responses were abolished by maximal coronary vasodilation with intravenous adenosine, augmented by combination with coronary sinus retroperfusion and reduced by coronary arterial ischemia. These findings indicate the presence of a compensatory regulating mechanism in the coronary circulation during ICSO. We should attach much importance to this mechanism for the effectiveness of ICSO. To be accurate, the changes in coronary arterial flow as well as CSP dynamics should be considered when choosing adequate occlusion-release intervals of ICSO.

Adenosine↗
PubMed1999

Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report.

A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case.

Arteriovenous Malformations↗
PubMed1984

[Elementary changes in the duration of successive sinus cycles; the concept of sinus extrasystole].

The authors studied the duration of successive sinus cycles in 35 patients confined to bed using a computerized system to trace graphs of heart rate (tachograms) with a resolution greater than +/- 2,5 ms due to precise detection of the upstroke of the R wave. A coupled visualization system excluded variations due to changes in the PR interval. Several types of modification were demonstrated: 1) slow fluctuations of high amplitude of the heart rate probably related to the autonomic nervous system or circulating catecholamines, 2) smaller variations of heart rate, from cycle to cycle with different forms of distribution: progressive increment or decrement over 3 to 4 cycles in 10 ms steps. This may be a system of intrasinus regulation for controlling variations of periods of 10 ms from one cycle to another. In both forms of distribution, the total amplitude of variation for a complete period of 3 to 4 cycles ranged from 30 to 75 ms. In some cases, sinus complexes were recorded with a prematurity of about 50 ms with respect to the preceding cycle and followed by an equivalent compensatory pause with respect to the last non-extrasystolic cycle. When the coupling interval of these premature complexes varied, the compensatory pauses remained unchanged. These results suggest a very precise system of control over the sinus rhythm, the mechanisms of which could be very varied: either cyclical variations of intrasinus conduction time from the same zone of automaticity to the atrium, or a sequential system of automaticity of slightly different frequencies obeying an unknown law; or again, electronic variations between two or more pacemakers of comparable frequency within the sinus node.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Complexes, Premature↗
PubMedDate not supplied

Massive osteolysis of skull bones secondary to lymphangioma of paranasal sinuses and mastoid sinus: report of two cases in children.

Massive osteolysis (MO) is a rare condition in which progressive localized bone tissue resorption is associated with proliferating thin-walled vessels in the absence of inflammation. Rare cases have been reported to occur in the skull. This paper describes two patients with MO who presented with massive assymetric swelling of the skull. This was associated with extensive enlargement of the paranasal sinuses (frontal, ethmoidal, and sphenoidal in one and the mastoid air cells in the other). The second patient developed subcutaneous emphysema on several occasions and the Valsalva maneuver increased the swelling, indicating transmission of the air from the nasopharynx to the mastoid cells and from there to the subcutaneous tissue. In the first patient, the sinus mucosa was shown to be involved by an extensive lymphangioma, and a similar change was seen in the mastoid air cells (patient 2). We are proposing that MO of these two patients resulted from bone resorption due to progressive extension of sinus mucous lymphangiomata.

Adolescent↗
PubMed1986

Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis.

The correlation of Waters view radiographs and A-mode ultrasound for diagnosing sinusitis was evaluated in 75 subjects with allergic rhinitis who presented with signs and symptoms suggesting sinus disease. All patients had Waters view radiographs, which were read by a radiologist (E. G.) who was not provided with historical information. Ultrasound tracings were obtained by registered nurses who were trained to perform this procedure. Tracings were interpreted by two representatives of American Electromedics Corporation, the manufacturer of the Echosine ultrasound machine used in this study. Most common symptoms among the patients were cough and rhinorrhea. The complaint of headache correlated negatively (p = 0.001) with an abnormal radiograph, whereas physical findings of copious and purulent rhinorrhea correlated positively (p = 0.05 and 0.001, respectively). Middle ear abnormalities on examination and tympanometry were more common in those with abnormal radiographs, p less than 0.05 and p less than 0.01, respectively. If the radiograph is considered to be a "gold standard," sensitivity of ultrasound varied from 44% to 58% and specificity from 55% to 61%, dependent on which criteria are applied to the radiograph to consider it normal. A-mode ultrasound is not sufficiently comparable to radiography to be used as its substitute for diagnosing sinus disease.

Adolescent↗
PubMed2000

Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus: report of four cases and review of the literature.

BACKGROUND: The aim of this study is to describe the technique and results of the endovascular approach through the thrombosed inferior petrosal sinus (IPS) for occlusion of dural cavernous sinus fistulas (DCSFs). METHODS: In four patients presenting with clinically symptomatic DCSFs, the angiogram did not show opacification of the IPS, indicating that it neither drained the arteriovenous fistula nor the cerebral venous outflow. A large volume biplane phlebogram of the jugular bulb was obtained to identify a thrombosed remnant of the IPS. We were able to navigate small hydrophilic catheters and microguide wires through the thrombosed IPS into the ipsi- or contralateral CS. After reaching the fistula site the CS was packed with detachable platinum coils. RESULTS: We were able to reach the fistula site and to achieve a dense packing of coils within the arteriovenous shunting zone in all of the patients. The final angiogram showed subtotal or complete occlusion of the arteriovenous fistula. All four patients recovered completely and showed disappearance of the fistula on follow-up arteriograms. One patient developed a transient sixth nerve palsy. No complications related to the approach were observed. CONCLUSIONS: For endovascular treatment, transvenous occlusion of DCSFs via the IPS is a feasible approach, even when this sinus is partially or completely thrombosed. Gentle handling of recently available, improved hydrophilic microguide wires and microcatheters allows effective and safe catheter navigation into the CS. A phlebogram of the jugular bulb is very useful for identification of a thrombosed IPS.

Aged↗
PubMed1998

Unexpected recurrence of sinus rhythm in chronic atrial fibrillation due to sick sinus disease.

A 60-years old patient with symptomatic sick sinus disease was implanted a dual-chamber pacemaker that did well during the following 13 years. Thereafter, the pacemaker had to be explanted because of a systemic infection, with the patient in constant chronic atrial fibrillation in the meantime. After another asymptomatic year, 6 arrhythmogenic syncopes occurred, apparently due to pre-automatic pauses prior to spontaneous conversions to sinus rhythm. Subsequently, the patient was implanted a VVI pacemaker, whereupon he did well henceforth. This case demonstrates the possibility of recurrence of sinus rhythm even after long-standing chronic atrial fibrillation.

Arrhythmia, Sinus↗
PubMed1979

Surgical treatment of chronic hyperplastic sinusitis and maxillary sinus empyema of oral/dental origin.

Twelve patients with maxillary hyperplastic sinusitis or maxillary sinus empyema of oral/dental etiology have been treated according to a modified surgical technique. The treatment was initiated by several oro-nasal irrigations and drainage facilitated by an intact semilunar hiatus. This was followed by a surgical procedure including conservative curettage of inflamed sinus mucosa, adequate closure of the oro/antral communication, with establishment of a postoperative oral antrostomy. This antrostomy, through the canine fossa, was established by a vacuum drain, enabling continuous postoperative irrigation and aspiration. The rationale for this technique is discussed. A total of 12 patients operated according to this technique are described. Complete clinical and radiographic healing in all patients was observed over a postoperative period ranging from 6-12 months.

Adult↗
PubMedDate not supplied

Microbiology of the maxillary and ethmoid sinuses in patients with chronic rhinosinusitis submitted to functional endoscopic sinus surgery.

UNLABELLED: Chronic rhinosinusitis microbiology studies show the presence of aerobe and anaerobe microorganisms, fungus and virus and their incidence vary according to each study. These studies guide us on choosing the most adequate antimicrobial agent to eliminate the infectious process, thus, helping in restoring rhinosinusal mucosa. STUDY DESIGN: Clinical prospective. AIM: This work aimed at studying the microbiology of the maxillary and/or ethmoid sinuses of patients with chronic rhinosinusitis and with indication of functional endoscopic sinus surgery. MATERIALS AND METHODS: During surgery, we collected secretion and/or fragments of maxillary and/or ethmoid sinus mucosa from 41 patients to perform Gram stain, fungus direct research, aerobe and anaerobe microorganism culture and fungus culture. RESULTS: We identified the presence of aerobe microorganisms in 21 patients (51.2%), anaerobe microorganisms in 16 (39%) and fungus in 1 (2.4%). In the studied population, only 12 patients (29.2%) presented microorganisms considered pathogenic when analyzed together with the semi-quantitative leukocyte count. Staphylococcus coagulase-negative and Staphylococcus aureus were the most frequent microorganisms found, in 5 (12.18%) and in 4 (9.75%) patients respectively. CONCLUSION: This study reveals that Staphylococcus coagulase-negative and Staphylococcus aureus were the most frequent microorganisms isolated from patients with chronic rhinosinusitis.

Adolescent↗