Coronary sinus right atrium inferior vena cava middle cardiac vein right pulmonary veins. It is oriented obliquely in the posterior atrioventricular groove. Normal coronary venous anatomy on volumerendered images from contrast materialenhanced coronary ct angiography. It is dependent on the site of the drainage of the posterolateral vein figure 1 2. The right aortic sinus which lies anteriorly, gives rise to the right coronary artery. Knowledge of the anatomy of the coronary sinus cs and cardiac venous drainage is important because of its relevance in electrophysiologic procedures and cardiac surgeries 3 4. To pace the left ventricle, the electrode is implanted in tributaries of the coronary sinus cs. It is found between the inferior vena cava and the tricuspid valve on the inferior part of the interatrial septum, forming a corner of kochs triangle. It returns the majority of the blood supply for the left ventricle to the right atrium. The coronary sinus cs represents the trigger site for a few atrial flutters and atrial tachycardias. Coronary cta protocols usually image the heart using cranialtocaudal acquisition. Coronary sinus definition, a large venous channel in the heart wall that receives blood via the coronary veins and empties into the right atrium.
Normal anatomy and congenital abnormalities article pdf available in radiographics 324. The coronary sinus ostium is an opening located between the inferior vena cava and the tricuspid valve on the inferior aspect of the interatrial septum. The anatomy of the artery has been described by many anatomic works. A the anatomy of the coronary sinus and tributaries is depicted at the first implant in a frontal projection. The sna originates from the right or left coronary arteries. The anatomy of the cardiovascular systemchapter 18. Pdf the anatomy of the coronary sinus venous system for the. The ostium of the coronary sinus is partially covered by the thebesian valve veins draining into the coronary sinus are highly variable, but usually, include. Coronary dominance refers to the artery giving rise to the post interventricular artery right dominant pda supplied by rca. The right ventricle, the right inferior portion of the heart, is the chamber from which the pulmonary artery carries blood to the lungs. The anatomy of the veins of the heart is very variable, but generally it is formed by the following veins. The anatomic basis of connections between the coronary sinus. There are three aortic sinuses dilations in the wall of the aorta just superior to the aortic semilunar valve. Coronary sinus definition is a venous channel that is derived from the sinus venosus, is continuous with the largest of the cardiac veins, receives most of the blood from the walls of the heart, and empties into the right atrium.
The implanting electrophysiologist is usually challenged by a high degree of variability in the coronary venous anatomy, making it important to have a more consistent and uniform segmental approach to describe the coronary venous tree and its. The left atrial myocardium and the coronary sinus muscle cuff were separated by adipose tissue. Cases were selected to show the normal coronary arterial and venous anatomy. The functional anatomy of the human coronary sinus. Coronary arteries supply blood to the heart muscle. The coronary sinus is the most constant feature of the cardiac venous system, although several congenital anomalies have been described 21. Sep 29, 2014 imaging of the coronary venous system has traditionally been overshadowed by that of the coronary arteries. Catheterablationofaccessorypathwaysnearthecoronary sinus.
Pdf anatomy of the coronary sinus and epicardial coronary. Interatrial communication through the mouth of the coronary sinus. Schematic diagram of the heart showing coronary sinus and its tributaries. Knowledge of the anatomy of the coronary sinus cs and cardiac venous drainage is important because of its relevance in electrophysi ologic procedures and. The anatomy of the coronary sinus and its tributaries. However, venous imaging has become increasingly important, since many cardiac interventions currently use the coronary venous system for left ventricular pacing, mapping and ablation of arrhythmias, retrograde cardioplegia, targeted drug delivery, and stem cell therapy. Take home points cardiovascular medicine boards and clinical practice it will take 1 year of fellowship to feel comfortable with interpreting coronary angiograms remember, in the setting of severe cad ctos, post bypass, etc.
The coronary sinus is the main vein of the heart, located on the posterior surface in the coronary sulcus, which runs between the left atrium and left ventricle. One hundred consecutive patients admitted for coronary angiography had a simultaneous coronary venography performed after the injection of 8. The coronary sinus is the gateway for left ventricular lv epicardial lead placement for cardiac resynchronization therapy. Jul 10, 2018 clinical anatomy cardiac coronary vessels left and right coronary artery, venous sinus. Connections between the coronary sinus and the left atrial myocardium. We describe both of these protocols because the cardiac venous anatomy may be displayed with variation in. The clinical anatomy of the sinus node artery the annals of. Imaging of the coronary venous system has traditionally been overshadowed by that of the coronary arteries. Distance learning program anatomy of the human heartpig. However, the anatomy of cardiac veins with this purpose in mind has not been described in detail. The coronary sinus is the largest cardiac venous structure. The coronary sinus empties directly into the right atrium near the conjunction of the posterior interventricular sulcus and the coronary sulcus crux cordis area, located between the inferior vena cava and tricuspid valve. Two coronary arteries originate from the left side of the heart at the beginning root of the aorta, just after the aorta exits the left ventricle. Up to five separate coronary ostia have been described figs.
Although absence of the coronary sinus is widely recognized in hearts with isomerism of the right atrial appendages, little attention has been paid to the. Upper portion of left aortic sinus just below the sinotubular ridge. Venous blood from lv collected by cardiac veins coalesce to form coronary sinus opens into ra. Goldberg a, southern d, galbraith pd, traboulsi m, knudtson ml, ghali wa. Coronary sinus anatomy the coronary sinus cs is the main cardiac vein and it has become a clinically important structure especially through its role in providing access for different cardiac procedures. Additional smaller ostia may be found in the right sinus, which give rise to multiple right ventricu lar branches fig. Mips were obtained using various thicknesses 530 mm and were displayed using standard orientations right anterior oblique, left anterior oblique, axial with or without caudal or cranial angulation.
Composition of human heart and its vasculature were subjects of numerous anatomical. Jun 30, 2006 to pace the left ventricle, the electrode is implanted in tributaries of the coronary sinus cs. Blood flow to heart through coronary arteries is called coronary circulation. Cardiac electrophysiologists use of the coronary sinus cs to map and ablate accessory pathways and implant left ventricular leads has emphasized the need for understanding cs anatomy. Take home points cardiovascular medicine boards and clinical practice understand normal coronary anatomy understand different imaging viewsprojections. Within the right atrium, the opening of the coronary sinus is located between the right atrioventricular orifice and the inferior vena cava orifice. The mouth of this saccular aneurysm was 6 mm, and was located in the distal portion of the coronary sinus near the ostium. The implanting electrophysiologist is usually challenged by a high degree of variability in the coronary venous anatomy, making it important to have a more consistent and uniform segmental approach to describe the coronary venous tree and its branches. Clinical anatomy cardiac coronary vessels left and right coronary artery, venous sinus.
C the anatomy of the coronary sinus has taken on new clinical importance as a result of the expansion of electrophysiological investigations and interventions. The coronary sinus cs drains 95% of the venous blood of the myocardial muscle into the right atrium, while the remaining 5% of myocardial venous flow drains through the thebesian vessels. Anatomy of the aortic root the annals of thoracic surgery. Learn more about the anatomy of the venous drainage of the heart in this tutorial. The coronary sinus is a collection of veins joined together to form a large vessel that collects blood from the heart muscle myocardium. Several procedures make use of the cs, such as left ventricular pacing, mapping and ablation of ar.
Clinical anatomy cardiac coronary vessels left and. Learn vocabulary, terms, and more with flashcards, games, and other study tools. However, caudaltocranial scanning acquisitions are implemented when concomitant imaging of the pulmonary arteries is desired in patients with atypical chest pain. The anatomy of the coronary sinus venous system for the cardiac. Anatomy and function of the coronary arteries johns hopkins. An appendix contains supplemental information on coronary sinus anatomy, tee imaging, fluoroscopy, and other aspects of cs catheter placement. Small branches dive into the heart muscle to bring it blood. The coronary arteries wrap around the outside of the heart.
The sinus commences at the junction of the great cardiac vein and the oblique vein of the left atrium. The specimen stained with hematoxylin and eosin shows the endocardium white arrows and the medial layer of striated myocardial muscle black arrows. Nov 01, 2009 cardiac electrophysiologists use of the coronary sinus cs to map and ablate accessory pathways and implant left ventricular leads has emphasized the need for understanding cs anatomy. Google scholar knauth a, mccarthy kp, webb s, et al. Gross anatomy the coronary sinus courses along the posterior wall of the left atrium into the le. International journal of anatomy and research, original.
Myocardial bridges were detected above the anterior interventricular vein or its tributaries in 8%. For the success of anatomical correction of transposition of the great arteries tga it is essential to transfer the coronary ostia to the posterior vessel without undue tension, torsion, or kinking of the proximal coronary arteries or their early branches. Patient factors such as cause of heart failure, type of dyssynchrony, scar burden, coronary sinus anatomy, and phrenic nerve capture may affect the efficacy of the therapy. The name comes from the latin corona, meaning crown.
Repair ofperivalvular leak in the area of the right coronary sinus by placement of pledgeted sutures from the right ventricular outflow tract. Anatomy of the coronary arteries in transposition of the. There is also a high degree of variability in the number of branches between the middle cardiac vein and the anterior interventricular vein. Significant blockage of a coronary artery will result in reduced blood flow to, and eventual death of the cells of the heart. Diagnostic performance of multidetector ct angiography for assessment of coronary artery disease. Normal and variant coronary arterial and venous anatomy on. The coronary sinus courses along the posterior wall of the left atrium into the left atrioventricular groove. Lessons learned by use of magnetic resonance imaging. Clinical anatomy cardiac coronary vessels left and right. The coronary sinus and its tributaries were studied by anatomical dissection in 37 adult human cadaveric hearts, which had been fixed in formalin solution. Anatomy and function of the coronary arteries johns. Blood flows from the right atrium to the right ventricle. The sinus node artery sna is an integral part of the sinus node sn, which is the natural pacemaker of the heart. Coronary arterial origin and course of the proximal main stems can be important indications for analysis of cardiac pathomorphology.
This requires thorough understanding of the different modes of origin and early branching of the coronary arteries in. Professor, chief, and cullen foundation endowed chair. Mar 09, 2015 the coronary sinus is a collection of smaller veins that merge together to form the sinus or large vessel, which is located along the hearts posterior rear surface between the left ventricle. Knowledge of the anatomy of the coronary sinus cs and cardiac venous drainage is important because of its relevance in electrophysiologic procedures and cardiac surgeries. Like all other tissues in the body, the heart muscle needs oxygenrich blood to function. The probe is advanced or withdrawn in the esophagus. Pdf angiographic anatomy of the coronary sinus and its. School of mechanical engineering, university of leeds. Myocardial bridges were detected above the anterior. Basic coronary angiography keck school of medicine of usc. Angiographic anatomy of the coronary sinus and its. Correlate knowledge to clinical conditions related to myocardial coronary circulation.
This inspired several groups as early as the mid90s to implant conventional pacemaker leads into coronary sinus tributaries for biventricular pacing via a yconnector. Coronary sinus is formed by the union of the greater cardiac vein and main posterolateral vein. It delivers lessoxygenated blood to the right atrium, as do the superior and inferior venae cavae. The coronary sinus is roughly a 3 cm saccular dilatation between the left cardiac chambers. The coronary sinus returns deoxygenated blood to the right atrium of the heart, together with the superior and inferior vena cavae.
Angiographic anatomy of the coronary sinus and its tributaries. The coronary sinus has been cut along its long axis. It continues as the great cardiac vein gcv in the left atrioventicular. Coronary arteries supply blood to the myocardium and other components of the heart. Assessment of coronary artery bypass graft patency by multislice computed tomography. Right ventricle blood enters the right ventricle via the tricuspid valve, which has anterior, septal and posterior lying inferiorly cusps attached to. Anatomy of the cardiovascular system key terms anastomosis arteriole artery atrium capillary endocardium endothelium epicardium. Blood supply is from the right coronary artery in 55% of cases, the circumflex branch of the left coronary artery in 45%. Coding of coronary arterial origin and branching in. Coronary sinus catheter placement edwards lifesciences.
Anatomy, histology, and pathology of coronary arteries. Mcv starts near apical region of the heart and runs in the posterior interventricular groove and joins the coronary sinus before it. In the morphologically normal heart, there is a fairly consistent coronary pattern consisting of 3 main branches connected by way of 2 orifices to the semilunar sinuses of the aorta. Coronary dominance and prognosis of patients with acute coronary syndrome. Pulmonary vein anatomy in patients undergoing catheter ablation of atrial fibrillation. The anatomy of the coronary sinus venous system for the. Coronary sinus definition of coronary sinus by medical.
In addition, the sinus itself could represent an arrhythmogenic area. Impulses spread from the sinus node over the atria, from right to lefttop to bottom, completing atrial depolarization in about 80100 ms although there. There has been a drive to avoid the valentine approach to cardiac description that has. The coronary sinus is a collection of smaller veins that merge together to form the sinus or large vessel, which is located along the hearts. The right ventricular rv lead is positioned near the apex and an old epicardial screwin helix is visible on the rv free wall. Coronary sinus ostium atlas of human cardiac anatomy. The myocardium drains mainly by two groups of veins. Other variable features of the coronary venous anatomy include the. Cannulation of the coronary sinus cs is a prerequisite for left ventricular lv pacing and certain ablation procedures. The coronary sinus ostium is an opening of the coronary venous system into the right atrium. This vein is seen accompanying the acute marginal branch of the right coronary artery rca. We highlight the correlations of the acquired anatomical. Pdf the anatomy of the coronary sinus venous system for.