Document Detail

Topographic analysis of the coronary sinus and major cardiac veins by computed tomography.
MedLine Citation:
PMID:  15992723     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The coronary sinus (CS) and its branches may play a role in the genesis of various arrhythmias. Applications of radiofrequency energy within the CS may be necessary. Atrio-esophageal fistula has been recognized as a complication of ablation along the posterior left atrial wall. OBJECTIVES: The purpose of this study was to describe the in vivo topographic anatomy of the CS, esophagus, and coronary arteries using computed tomography (CT). METHODS: Helical contrast CT of the heart with three-dimensional and endoscopic reconstructions was performed in 50 patients (28 men and 22 women; mean age 54 +/- 10 years). The images were reformatted to determine the relationships among the CS, adjacent blood vessels, and esophagus and to determine the nature and thickness of surrounding tissue layers. RESULTS: Mean CS ostium diameter was 12 +/- 4 mm, and mean thickness of the periosteal fat layer was 3 +/- 2 mm. In 40 of the 50 patients (80%), the esophagus was adjacent to the CS, starting 24 +/- 9 mm from the ostium, and remained in contact for a mean length of 7 +/- 5 mm. Mean thickness of the fat layer between the esophagus and CS was 1 +/- 1 mm, and mean thickness of the anterior wall of the esophagus was 3 +/- 2 mm. In 10 patients (20%), there was no contact between the esophagus and CS. In 40 patients (80%), the right coronary artery was less than 5 mm from the CS (minimum distance 1 +/- 1 mm) over a mean length of 17 +/- 11 mm. In all patients, the circumflex artery was less than 5 mm from the CS (minimum distance 1 +/- 0.4 mm) over a mean length of 16 +/- 9 mm in patients with right-dominant coronary circulation and over a mean length of 86 +/- 11 mm in patients with left-dominant coronary circulation. CONCLUSION: The CS often lies very close to the esophagus and coronary arteries. During radiofrequency energy ablation in the CS, caution should be exercised to prevent injury to surrounding structures.
Kristina Lemola; Gisela Mueller; Benoit Desjardins; Michael Sneider; Ian Case; Eric Good; Jihn Han; Kamala Tamirisa; David Tschopp; Scott Reich; Petar Igic; Darryl Elmouchi; Aman Chugh; Frank Bogun; Frank Pelosi; Ella A Kazerooni; Fred Morady; Hakan Oral
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  2     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-04     Completed Date:  2005-10-27     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  694-9     Citation Subset:  IM    
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-0311, USA.
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MeSH Terms
Aortic Aneurysm, Thoracic / pathology,  physiopathology,  radiography*
Atrial Fibrillation / pathology,  physiopathology,  radiography*
Coronary Artery Disease / pathology,  physiopathology,  radiography*
Coronary Circulation / physiology
Coronary Vessels / pathology*,  physiopathology
Esophagus / radiography
Imaging, Three-Dimensional
Middle Aged
Tomography, Spiral Computed

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