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Surgical and Radiologic Anatomy

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01-03-2021 | Original Article

The behavior of three types of large sinus node arteries with regard to the blood supply of the atrial myocardium

Authors: Christos E. Nerantzis, Hector Anninos, Soultana K. Marianou, Sokratis Pastromas

Published in: Surgical and Radiologic Anatomy | Issue 3/2021

Abstract

Purpose

We describe angiographic findings of sinus node arteries (SNAs), focusing in the large sinus node artery (LSNA) variants, regarding the blood supply of the SN and atrial myocardium.

Methods

We examined the SN arteries via postmortem angiographic visualization in six hundred hearts derived from victims of various accidents.

Results

The main stem or a branch of the SNA supplied the right atrium (RA) and part of the interatrial septum (IS) in 32% of cases (Group A), one atrium, the IS and a small part of the other atrium (Group B) in 39% and the entire atrial myocardium (LSNAs) (Group C) in 29%. Forty-two percent (42%) of LSNAs were arising from the anterior part of the right coronary artery (RCA) (type 1), 9% from its intermediate part (type 2) and 49% from the posterolateral portion of the left circumflex artery (LCx) (type 3). Type 2 can be injured by surgical procedures, type 3 by interventional ones, while type 1 is not affected by any. The SN area was supplied in Groups A and B by the main stem of SN arteries in 370 cases (62%) and by branches (Br) in 55 (9%). The 175 cases of group C (29%) were supplied only by branches. The clockwise (40% of cases) and counterclockwise rotations (60%) of the SNA around the superior vena cava, concern surgical procedures.

Conclusion

The above findings are essential for every day surgical and interventional procedures.

Anderson RH, Razavi R, Taylor AM (2004) Cardiac anatomy revisited. J Anat 205:159–177CrossRef

Berdais D, Patonay L, Turina MI (2003) The clinical anatomy of the sinus node artery. Ann Thorac Surg 76:732–736CrossRef

Boppana VS, Castaño A, Avula UMR, Yamazaki M, Kalifa J (2011) Atrial coronary arteries: anatomy and atrial perfusion territories. J Atr Fibril 4:375

Davies MJ, Pomerance A (1972) Quantitative study of aging changes in the human sinoatrial node and internodal tracts. Br Heart J 34:150–152CrossRef

Gaudino M, Nasso G, Minati A, Salica A, Luciani N, Morelli M, Gianfederico P (2003) Early and late arrhythmias in patients in preoperative sinus rhythm submitted to mitral valve surgery through the superior septal approach. Ann Thorac Surg 75:1181–1184CrossRef

Gavrielatos G, Nerantzis CE (2011) Post mortem coronary angiographic visualization of a rare sinus node artery, anatomical variant. Hellenic J Cardiol 52:84–85PubMed

Haissaguerre M, Jais P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in pulmonary veins. N Engl J Med 339:659–666CrossRef

Halon DA, Sapoznikov D, Lewis BS, Gotsman MS (1983) Localization of lesions in the coronery circulation. Am J Cardiol 52:921–926CrossRef

Huntcinson MCE (1978) A study of the atrial arteries in man. J Anat 125:39–54

10.

James TN, Burch GE (1958) The atrial coronary arteries in man. Circulation 17:90–98CrossRef

11.

James TN (1973) The sinus node as a servomechanism. Cir Res 32:307–313CrossRef

12.

Mori S, Spicer DE, AndersonRH, (2016) Revisiting the anatomy of the living heart. Circ J 80:24–33CrossRef

13.

Nerantzis C, Avgoustakis D (1980) An S-shaped atrial artery supplying the sinus node. An anatomical study. Chest 78:274–278CrossRef

14.

Nerantzis CE, Toutouzas P, Avgoustakis D (1983) The importance of the sinus node artery in the blood supply of the atria myocardium. An anatomical study of 360 cases. Acta Cardiol 38:35–47PubMed

15.

Nerantzis CE, Marianou SK, Koulouris SN, Agapitos EB, Papaioannou JA, Vlahos LJ (2004) Kugel’s artery: an anatomical and angiographic study using a new technique. Tex Heart Inst J 31:267–270PubMedPubMedCentral

16.

Nerantzis CE, Gavrielatos G, Lefkidis CA, Koutsaftis PN (2009) A secret pathway of the sinus node artery. Foren Sci Int 186:e25-26CrossRef

17.

Nerantzis CE, Anninos H, Koutsaftis PN (2010) Variation in the blood supply of the sinus node. Surg Radiol Anat 32:983–984CrossRef

18.

Nerantzis CE, Koulouris S, Pastromas S (2011) Sinus node artery originating from the posterior part of the right coronary artery. Surg Radiol Anat 33:373–375CrossRef

19.

Nerantzis C, Bouzianis S, Theocharis S (2017) A long sinus node artery with an unusual origin and course. A case report. Eur J Anat 21:161–163

20.

Pappone C, Oreto G, Rosanio S et al (2001) Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 104:2539–2544CrossRef

21.

Pejković B, Krajnc I, Anderhuber F, Kosutić D (2008) Anatomical aspects of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human heart. J Int Med Res 36:691–698CrossRef

22.

Romhild DW, Hackel DB, Ester IH Jr (1968) Origin of blood supply to sinoauricular and atrioventricular node. Am Heart J 75:279–281CrossRef

23.

Schlesinger MJ (1940) Relation of anatomic pattern to pathologic conditions of the coronary arteries. Arch Path 30:403–415

24.

Utley JR, Leyland SA, Nguyenduy T (1995) Comparison of outcomes with three atrial incisions for mitral valve operations. J Thorac Cardiovasc Surg 109:582–587CrossRef

Title: The behavior of three types of large sinus node arteries with regard to the blood supply of the atrial myocardium
Authors: Christos E. Nerantzis
Hector Anninos
Soultana K. Marianou
Sokratis Pastromas
Publication date: 01-03-2021
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 3/2021
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-020-02621-5

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The behavior of three types of large sinus node arteries with regard to the blood supply of the atrial myocardium

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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