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At least 19 recordsLinked to original sources
PubMed1995

Unroofed coronary sinus and coronary sinus orifice atresia. Implications for management of complex congenital heart disease.

OBJECTIVES: The aim of this study was to assess the morphology of the coronary sinus, its drainage and associated cardiac malformations when there is either complete unroofing of the coronary sinus or atresia of its connection to the right atrium. BACKGROUND: As more children with complex cardiac anomalies are accepted for primary surgical repair or palliation with cavopulmonary anastomoses, a knowledge of coronary sinus and systemic venous anomalies is important if coronary venous return is to be preserved and residual shunts avoided. METHODS: Twenty-six heart-lung specimens without a coronary sinus draining to the right atrium were identified from the Leiden collection of congenital heart malformations. These were classified into specimens with an unroofed coronary sinus and those with atresia of the coronary sinus orifice. Attention was paid to the associated cardiac malformations. RESULTS: In 14 (54%; confidence limits [CL] 35%, 73%) of 26 specimens, there was an unroofed coronary sinus, associated with persistence of the left superior caval vein. An inferoposterior location of an atrial septal defect was detected in 2 (14%; CL -4%, 33%) of 14. Atrial appendage anomalies were seen in 13 (93%; CL 79%, 106%) of 14 specimens, exemplified by both right and left isomerism. These were frequently associated with an atrioventricular septal defect (12 [86%; CL 67%, 104%] of 14). An atretic coronary sinus orifice was seen in 12 (46%; CL 27%, 65%) of 26. Atrial appendage anomalies (2 [17%; CL -4%, 38%] of 12) were rare in these cases. The drainage was then by way of a left superior caval vein or, in its absence, a coronary sinus to left atrial window. Ventricular hypoplasia was seen in both categories of coronary sinus abnormalities. Important ventricular hypoplasia was seen in 12 cases (46%; CL 27%, 65%). CONCLUSIONS: These findings emphasize the need to study coronary sinus drainage before procedures such as ligation or transcatheter coil embolization of a left superior caval vein, venous redirection or closure of a dorsal atrial septal defect are contemplated. These procedures might inadvertently lead to impairment of coronary venous return or persistence of an intracardiac shunt.

Coronary Vessel Anomalies↗
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↗
PubMed1988

Estimation of the secretion rate of atrial natriuretic peptide from the coronary sinus in coronary artery disease.

Although atrial natriuretic peptide (ANP) is known to be secreted through the coronary sinus into the systemic circulation, its actual secretion rate has not been thoroughly investigated. The immunoreactive ANP concentrations in plasma samples from the ascending aorta and coronary sinus in 11 patients with the coronary artery disease were measured and the coronary sinus flow rate using the continuous thermodilution method was simultaneously determined at the time of sampling. These variables were also determined during the intravenous infusion of synthetic alpha-human ANP at 0.025 microgram/kg.min in 7 of the 11 patients. In the basal state, the plasma concentration of ANP was 61 +/- 6 (standard error) pg/ml in the aorta and 541 +/- 40 pg/ml in the coronary sinus, and the coronary sinus flow index was 57.3 +/- 12.3 ml/min.m2. Thus, the secretion rate of ANP was determined to be 14.4 +/- 2.8 ng/min.m2. The secretion rate of ANP correlated significantly with the plasma concentration of ANP in the aorta (r = 0.65, p less than 0.05). The ANP infusion, which decreased pulmonary artery wedge pressure from 8.0 +/- 0.6 to 6.3 +/- 0.4 mm Hg (p less than 0.01), elevated the plasma concentrations of ANP in the aorta and coronary sinus by 701% (p less than 0.001) and 33% (p less than 0.05), respectively, and decreased the secretion rate of ANP by 40% (p less than 0.05). These results suggest that the circulating plasma concentration of ANP may reflect the secretion rate of ANP and that an increase in circulating ANP directly or indirectly reduces ANP secretion.

Aorta↗
PubMed2005

Intermittent coronary sinus occlusion complicating coronary sinus cannulation during coronary artery bypass operation.

Coronary sinus (CS) thrombosis is a rare event, usually complicating invasive procedures that cause trauma to the CS. Based on anecdotal case reports, this pathology is frequently associated with serious complications and is commonly fatal. We describe a case of intermittent CS thrombosis resulting from CS cannulation during coronary artery bypass grafting operation. This complication was further complicated by myocardial infarction, left ventricular free wall rupture, and pseudoaneurysm formation. The characteristic echocardiographic findings and a review of the literature on this rare complication are presented.

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↗
PubMed1985

An enzyme histochemical study of human sinus node, coronary sinus, and mitral valve muscle.

An enzyme histochemical study of the sinoatrial node, the coronary sinus, and the atrial muscle extending into the anterior mitral valve was performed on human hearts. Investigation of the activity and localization of the structurally bound enzymes was performed by conventional histochemical techniques. Determination of the activity of nonstructurally or weakly structurally bound enzymes was performed by histochemical techniques in which leakage of enzymes during the incubation period was reduced by the application of semipermeable membranes. The sinoatrial node is characterized by a high degree of anaerobic enzyme capacity and a relatively low degree of aerobic enzyme capacity. The discriminatory nature of these reactions allows examination of the structure of the sinoatrial node and its approaches. The presence of transitional cells was confirmed; isolated clusters of nodal cells were found in the atrial myocardium around the sinoatrial node, but no evidence of specialized tissue forming the beginning of an internodal pathway was found by this technique. The specific histochemical reactions that characterize the sinoatrial node also occur in the atrial muscle, extending into the anterior mitral valve, the anterior wall of the coronary sinus, and the atrial tissue near the orifice of the coronary sinus. These observations seem to corroborate the hypothesis that arrhythmic ectopic foci can arise in these regions.

Acetylcholinesterase↗
PubMed2005

Anatomical repair of partially unroofed coronary sinus syndrome through the coronary sinus orifice.

A 15-year-old girl was admitted for repair of partially unroofed coronary sinus syndrome. A preoperative echocardiographic study disclosed the dilated coronary sinus and a draining blood flow into the right atrium from both the left atrium and the end of the coronary sinus. At surgery, the distal portion of the coronary sinus roof was found to be absent. The defect was repaired through the coronary sinus orifice with a patch. No electrophysiological conduction abnormalities developed and follow-up echocardiography showed neither residual shunts nor coronary sinus blood flow disturbances.

Adolescent↗
PubMed1990

Morphology of the region of the coronary sinus in respect to coronary sinus rhythm.

The arterial supply to the region of the coronary sinus and the interatrial septum was examined in 18 normal canine hearts. In 13 of a further 18 dogs, coronary sinus rhythm was evoked by the ligation of atrial arteries, subsequent to which the arteries were visualized by injection of latex. A stable coronary sinus rhythm is evoked by producing ischaemia in an extensive area of the right atrium, including the sinus node, the interatrial septum and Bachmann's bundle, but preserving from ischaemia the posteroinferior part of the right atrium. Microscopical examination of the hearts with coronary sinus rhythm, and comparison with 9 control hearts, failed to demonstrate any morphological centre, in the form of nodal cells, which might have been responsible for the abnormal rhythm. In the posterior part of the right atrium, the ischaemic changes failed to affect the approaches of the atrioventricular node. The approaches were predominantly composed of cells poor in myofibrils mixed to a variable degree with cells of the working myocardium. We discuss the possibilities of the development of coronary sinus rhythm and "circus movement" with regard to the participation of the approaches to the atrioventricular node.

Animals↗
PubMed1975

Hypoplasia of the coronary sinus with coronary venous drainage into the left ventricle by way of the Thebesian system.

A 60-year-old woman with recent onset of exertional chest pain, left anterior hemiblock and negative stress electrocardiogram was found to have hypoplasia of the coronary sinus with drainage of the major coronary venous blood by way of the Thebesian system into the left ventricle. This abnormality appeared to be of no great functional significance.

Coronary Circulation↗
PubMedDate not supplied

Leukocyte CD15 expression and platelet activation in the coronary sinus after coronary intervention.

Markers associated with coronary restenosis must be identified to develop therapeutic strategies for improving the clinical outcome. We studied whether adhesion proteins on leukocytes and platelets from coronary sinus blood were associated with restenosis after coronary intervention in patients with stable coronary artery disease. Adhesion proteins on platelets and leukocytes were measured by flow cytometry. Pre- and postinterventional leukocyte CD15 expression was significantly higher in patients with restenosis than in those without it. Increased leukocyte CD15 expression during the intervention may contribute to coronary restenosis. Inhibition of leukocyte adhesion may be useful for the prevention of restenosis.

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↗
PubMed2004

High-density mapping of left atrial endocardial activation during sinus rhythm and coronary sinus pacing in patients with paroxysmal atrial fibrillation.

INTRODUCTION: This study was designed to record global high-density maps of left atrial endocardial activation during sinus rhythm and coronary sinus pacing. METHOD AND RESULTS: Noncontact mapping of the left atrium was performed in nine patients with paroxysmal atrial fibrillation undergoing pulmonary vein ablation procedures. High-density isopotential and isochronal activation maps were superimposed on three-dimensional reconstructions of left atrial geometry. Mapping was repeated during pacing from sites within the coronary sinus. Earliest left atrial endocardial activation occurred anterior to the right pulmonary veins in seven patients and on the anterosuperior septum in two patients. A line of conduction block was seen in the posterior wall and inferior septum in all patients. The direction of activation in the left atrial myocardium overlying the coronary sinus was different from the electrogram sequence in the coronary sinus catheter in 6 of 9 patients. During coronary sinus pacing, activation entered the left atrium a mean (SD) of 41 (13) ms after the pacing stimulus at a site 12 (10) mm from the endocardium overlying the pacing electrode. Lines of conduction block were present in the posterior wall and inferior septum. CONCLUSION: In patients with paroxysmal atrial fibrillation, lines of conduction block are present in the left atrium during sinus rhythm and coronary sinus pacing. Electrograms recorded in the coronary sinus infrequently correspond to the direction of activation in the overlying left atrial myocardium.

Adult↗
PubMed1988

Experimental study of acute coronary sinus thrombosis--clinical references to coronary sinus thrombosis and coronary venography.

The study was carried out to ascertain the effects caused by thrombosis in the coronary venous system. The coronary sinus (CS) of 21 adult mongrel dogs was abruptly obstructed to produce acute CS thrombosis. These dogs were then tested for serial changes of ECG, coronary arterial blood flow (CBF), left ventricular pressure (LVP), serum enzymes originating from the injured myocardium and histological changes of myocardium. Furthermore, the clinical application of a new coronary venography procedure was investigated. The results obtained in these experiments were as follows; (1) When the CS thrombosis was produced by the abrupt obstruction of the sinus, ECG patterns and serum enzymes originating from the myocardium showed changes similar to those of acute myocardial infarction. (2) The histological examinations showed that the changes in myocardial infarction were characteristically similar to those of hemorrhagic infarction. (3) Despite the complete obstruction of the coronary-venous system by thrombosis, the development of thrombosis or obstruction was not observed on the coronary-arterial side. This phenomenon is probably due to the recirculation of blood flow through the Thebesian vessels. (4) The experiment confirmed that the clear coronary venograms were easily obtained, without any risk, by the fixation of a balloon-tipped catheter inside the CS.

Animals↗
PubMed1989

Intermittent coronary sinus occlusion after coronary arterial ligation results in venous retroperfusion.

Coronary sinus occlusion retards necrosis of ischemic myocardium. To test the hypothesis that coronary sinus occlusion induces retrograde venoarterial flow, the coronary arteriovenous pressure gradient and the coronary arterial oxygen saturation were measured distal to a left anterior descending coronary artery ligature in dogs. In parallel, we constructed a mathematical model of known coronary physiology to characterize pressure and flow patterns during coronary sinus occlusion. In dogs, coronary sinus occlusion produced a systolic pressure gradient between the coronary artery and the coronary sinus of -20 +/- 9 mm Hg (higher venous pressure, p less than 0.0001) and a positive diastolic gradient of 3 +/- 5 mm Hg (lower venous pressure p less than 0.01). An average reduction in the oxygen saturation in the ligated coronary artery of 20 +/- 13% was also observed (p less than 0.005) consequent to admixture of venous (desaturated) blood. By graded inflation of the coronary sinus balloon, it was demonstrated that desaturation of arterial blood typically occurs above a coronary sinus systolic pressure of 40-50 mm Hg. The mathematical model indicates the possibility of venoarterial pressure gradients and reversal of flow at the microcirculatory level during coronary sinus occlusion. These studies provide evidence that retrograde flow into the ischemic zone occurs in association with intermittent coronary sinus occlusion. Thus, alternating flow over the ischemic territory may be the mechanism of myocardial salvage during intermittent coronary sinus occlusion.

Animals↗