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Sulcus terminalis of the right atrium. 1, superior vena cava; 2, right auricle; 3, sinoatrial node artery; 4, sinoatrial node
Source publication
Classic anatomical dissection of 150 hearts from adults aged 18 - 80 years was performed. The sinoatrial (SA) node artery was most frequently a large atrial branch of the right coronary artery (63%), arising at a mean distance of 1.2 cm (range 0.2 - 2.2 cm) from its beginning, with a mean external diameter of 1.7 mm (range 1 - 3 mm). In 37% of case...
Context in source publication
Context 1
... from the circumflex branch of the left coronary artery with the right coronary artery (Fig. 2). The SA node artery divided into two branches: one that ascended to the upper part of the left atrium and the other that went to the junction of the right auricle and superior vena cava (sulcus terminalis atrii dextri), where it entered the SA node (Fig. 3), pierced it and, after leaving the node, then encircled the ostium of the superior vena ...
Citations
... The sinoatrial node is located in the wall of the right atrium, in the upper part of the sulcus terminalis at the junction of the superior vena cava and the right atrium, and functions as the pacemaker of the heart (Futami et al. 2003;Kawashima and Sasaki 2003;Standring 2021). The sinoatrial node artery (SANa), an artery whose origin, number, size, and course are reported to be variable, irrigates, among other cardiac structures, the sinoatrial node (Boulemden et al. 2019;Esrailian et al. 2023;Nerantzis et al. 2021;Ortale et al. 2006;Pejković et al. 2008;Shimotakahara et al. 2014;Vikse et al. 2016). As a result, it is clinically relevant, in addition to being anatomically significant, given that it is used as a landmark for the identification of the sinoatrial node (Kawashima and Sasaki 2003;Standring 2021;Vikse et al. 2016). ...
Several studies reported anatomical variations in the sinoatrial node artery (SANa). Here, we report a rare variation in the origin of the SANa on a human adult male cadaver. During dissection, we identified the SANa originating from a large atrial branch of the right coronary artery (RCA). This branch originates at the level of the inferior border of the heart and courses upwards. The initial part of this vessel is tortuous, and then it follows a straight path parallel to the RCA along the anterior surface of the right atrium. After this part, the artery curves posteriorly and to the left until it reaches the lower border of the right auricle, where it closely approaches the RCA. Finally, the artery runs posteriorly and to the right to follow a course along the medial wall of the right auricle and right atrium to reach a location close to the region of the junction of the superior vena cava and right atrium, where it follows its path buried in the myocardium. After perforating the myocardium, this vessel gives rise to branches that are distributed to both atria in addition to the SANa. The SANa runs to the sinoatrial node in a precaval (anterior to the superior vena cava) course. We also tried to characterize the vessels radiologically. The knowledge of the anatomical variations of the SANa is of the utmost importance for cardiologists and heart surgeons to better understand cardiac disease and accurately plan and execute cardiac interventions and surgical procedures.
... Previous reports indicate that the SANB originates from the RCA in all cases in pigs and sheep (Crick et al., 1998;Gómez and Ballesteros, 2013) and in horses, this branch originates from the LCXB of the LCA in all specimens studied (Gómez et al., 2017b). In humans, SANB is reported to originate from the RCA in 50%-79% of the samples, from the LCXB in 30%-45%, and from both arteries in 3%-7% of the hearts (Pejković et al., 2008;Ballesteros et al., 2011). In our study, we found a similar origin of this branch as in humans, emerging mainly in a unique way directly from the LCA or from the LCXB, but with a significant percentage of dual emergence between the RCA and the LCA (46.4%), which guarantees excellent irrigation to the sinoatrial node and therefore its proper functioning in this species. ...
Background
The left coronary artery (LCA) in the bovines is more developed than the right.
Aim
The objective of the study is to describe the bovine coronary system from a morphological point of view, including the morphometry and its distribution.
Methods
Arciform suture with 2.0 silk was applied around the sinus orifice and coronary ostium and a number 14 catheter was installed, to perfuse semi-synthetic polyester resin, consisting of a mixture of 85% GP40L palatal with 15% styrene with red color mineral.
Results
The average weight of 28 bovine hearts used in our study was 1.534.1 kg. The right coronary artery had a proximal caliber of 5 +/− 0.9 mm. The LCA caliber and length were 9.4 +/− 1.2 and 18.3 +/− 4.8 mm, respectively. This artery was divided into two branches in 85.7% of the cases and trifurcated in 14.3%. The paraconal interventricular branch (PIB) ended more frequently in the apex (46.4%), and its proximal caliber was 6.4 +/− 1.4 mm. The left circumflex branch ended in 82.1% in the subsinusal interventricular sulcus, and its proximal caliber was 5.9 +/− 1.2 mm. The proximal calibers of the PIB and the left circumflex branch did not present statistically significant differences (p = 0.137). The sinoatrial branch presented a dual origin (right and LCA) in 46.4% of the cases and a single origin from the LCA in 53.6% of the samples. In the evaluated hearts, left coronary dominance was observed in most cases (96.4%). Their presence of anastomosis between the branches of the coronary arteries was observed in 57.1% of cases.
Conclusion
The presence of a myocardial bridge was found in six hearts (21.4%). In bovines, a high percentage of anastomosis was found, a protective factor in obstruction of the coronary arterial branches.
... The atrioventricular nodal artery (AVNA), located deeply in the heart wall, originates predominantly from the "U" turn of the right coronary artery (RCA) at the level of crux cordis, and less commonly from the distal left circumflex coronary artery (LCX). The length of the artery depends on the prominence of the "U" segment of origin (Pejkovi c et al., 2008). There are variations in the course of the AVNA in regard Abbreviations: AVNA, atrioventricular nodal artery; AV, atrioventricular; AVNRT, atrioventricular nodal reentry tachycardia; LAD, left anterior descending artery; LCA, left coronary artery; LCX, left circumflex coronary artery; IIVA, inferior interventricular artery; RBB, right bundle branch; RCA, right coronary artery. ...
... Eventually, 33 articles met the required criteria and were used in this meta-analysis (James & Burch, 1958;Romhilt et al., 1968;Vieweg et al., 1975Vieweg et al., , 1982Hutchinson, 1978;Anderson & Murphy, 1983;Brugada et al., 1990;Wang et al., 1990;Sneddon et al., 1991;Burke et al., 1993;Krupa, 1993;Sow et al., 1996;Arid et al., 2000;Lin, 2000;Sanchez-Quintana et al., 2001;Futami et al., 2003;Kaplana, 2003;Berdajs et al., 2008;Pejkovi c et al., 2008;Saremi et al., 2008;Nerantzis et al., 2009;Paulsen & Vetner, 2009;Ramanathan et al., 2009;Rusu et al., 2009;Ballesteros et al., 2010;El-Maasarany et al., 2010;Cezlan et al., 2012;Kazemisaeid et al., 2012;Sabnis & Silotry, 2012;Verma et al., 2014;Divyaprakash et al., 2016;Kawashima & Sato, 2018;Iwanaga et al., 2023). The overall data collection process can be found in Figure 1. ...
The objective of the present meta-analysis was to evaluate recent and applicable data regarding the location and variation of the atrioventricular nodal artery (AVNA) in relation to adjacent structures. In order to minimize postoperative risks and maintain physiological anastomosis for proper cardiac function, understanding such possible variations of vascularization of the AV node is of immense importance prior to cardiothoracic surgery as well as ablations. In order to perform this meta-analysis, a systematic search was conducted in which all articles regarding, or at least mentioning , the anatomy of the AVNA was searched. In general, the results were based on 3919 patients. AVNA was found to originate only from the RCA in 82.41% (95% CI: 79.46%-85.18%). The pooled prevalence of AVNA originating only from LCA was found to be 15.25% (95% CI: 12.71%-17.97%). The mean length of AVNA was found to be 22.64 mm (SE = 1.60). The mean maximal diameter of AVNA at its origin was found to be 1.40 mm (SE = 0.14). In conclusion, we believe that this is the most accurate and up-to-date study regarding the highly variable anatomy of the AVNA. The AVNA was found to originate most commonly from the RCA (82.41%). Furthermore, the AVNA was found to most commonly have no (52.46%) or only one branch (33.74%). It is hoped that the results of the present meta-analysis will be helpful for physicians performing cardiothoracic or ablation procedures.
... Identifying the variations in the blood supply to the AV node is relevant in not only clinical procedures but also surgical ones involving the coronary arteries [14]. Traditionally, the atrioventricular nodal branch (AVNb) has been reported to be located at the crux cordis, originating either from the right coronary artery (RCA) or branches off of the left coronary artery (LCA)/circumflex branch of the LCA (LCxA) and continuing into the triangle of the atrioventricular node (Koch's triangle) [15,16]. According to Futami et al., the majority of AVNb run into the myocardium of the inferior interventricular sulcus and continue along the septal margin of the right AV valve toward the AV node, and in one case, the AVNb originated from the SN nodal branch and descended toward the AV node [10,17]. ...
... The presence of AV block demonstrates prolonged conduction from the atria to the ventricles, typically seen in increased vagal tone in younger patients and greater fibrotic changes in older patients [32]. In patients with nonatherosclerotic narrowing of the AVNb, it has been implicated as a cause of sudden cardiac arrest due to a dramatic decrease in blood supply to the musculature, as well as to the AV node [16]. The importance of the diameter of the AVNb might also play a role in a patient's likelihood of experiencing sudden death [33]. ...
Background
The atrioventricular (AV) node is a relay station for electrical signals passing between the atria and ventricles. The artery supplying the AV node is functionally important, and its anatomical topography is relevant during invasive procedures. Therefore, the aim of this study was to identify and understand the variations of the origin of the AV nodal branch (AVNb) and its variations.
Materials and methods
We dissected 31 adult human hearts to evaluate their AVNb and its variations. A classification scheme was used to detail the morphology found for each of these arteries.
Results
We identified five distinct origins of the AVNb: AVNb originating from the right coronary artery (RCA) proximal to the inferior interventricular branch (IVb) (type I, 3.2%), AVNb originating from the junction of the RCA and IVb (type II, 19.4%), AVNb originating from the RCA distal to the IVb (type III, 64.5%), AVNb originating from the IVb (type IV, 6.5%), and AVNb originating from the circumflex branch of the left coronary artery (LCA) (type V, 6.5%).
Conclusions
Our study provides data on the morphology and variations of the AVNb. Such information can assist in better diagnoses based on imaging, better guide invasive procedures, and provide the cardiac surgeon with an improved method of classifying the AVNb and its branches during procedures of the coronary arteries and their branches.
... One of the most significant branches of the heart is the sinoatrial nodal artery, that supplies SA node, which is responsible for starting each heartbeat (Sañudo et al., 1998). In about 60% of people the sinoatrial nodal artery originates from the right coronary artery and in the remaining 40% of cases it arises from left circumflex coronary artery (Pejković et al., 2008). The current study examined the structural variations of the coronary artery patterns that supply the heart and examines their importance in the management of arrhythmias and other cardiac conditions. ...
... cm) from its beginning. 2 In less than 1% of cases, the artery originates from the distal RCA. 3 The posterolateral artery, also known as the posterior left ventricular artery, arises from the RCA in a typical dominant circulation. It is a terminal branch that supplies the inferior portion of the heart along with the posterior descending artery (PDA). ...
We discuss a case report of a 66-year-old male with no prior cardiac history who presented to the hospital with persistent hiccups and shortness of breath. Following a positive nuclear stress test and cardiac catheterization, a rare anatomical variant of a sinoatrial nodal artery originating from the right posterolateral artery was revealed.
... The main causes of sinus node dysfunction can be differentiated into intrinsic (e.g., degenerative idiopathic fibrosis, cardiac remodeling, ischemia, etc.), or extrinsic (medications, metabolic abnormalities, or autonomic imbalances) [3]. Among these, advanced age causing secondary fibrosis and subsequent dysfunction of the SA node is the most common cause [5]. Myocardial ischemia which is caused by the imbalance between myocardial oxygen supply and demand has also been shown to be a cause of sinus node dysfunction especially when the blood supply to the sinus node itself is compromised. ...
Bradyarrhythmia commonly occurs because of degenerative fibrosis in the conductive system. Ischemic disease is a rare etiology and limited cases have demonstrated direct evidence of ischemia to the sinus node vessels. We report a 62-year-old Hispanic male with a significant medical history of diabetes mellitus type II (DM II), hypertension, and dyslipidemia who was admitted to our hospital for symptomatic sinoatrial (SA) exit block. Patient had no electrolyte abnormalities and our differential included ischemic vs. fibrotic or infiltrative pathologies, giving symptomatic bradycardia, cardiac chest pain, and high-risk factors for coronary artery disease. We decided to take him for cardiac catheterization which revealed sluggish, pulsatile flow into the SA nodal artery due to severe stenosis of the ostial right coronary along with sever distal left circumflex (LCX) lesion. The flow into the sinus nodal artery (SNA) markedly improved post percutaneous coronary intervention (PCI) of the right coronary artery (RCA) and distal LCX and restoration of flow into SNA. Resolution of his bradyarrhythmia and symptoms post intervention confirmed our suspicious for reversible ischemic sinus node dysfunctions. Therefore, ischemic pathologies should be thought of when other common etiologies are less likely. Coronary angiogram should be considered prior to pacemaker evaluation in these setting to avoid missing reversible causes of bradyarrhythmia.
... ) from the beginning of this vessel[17]. It was usually the largest atrial branch of the right coronary artery; The initial part of the artery (1 -2 cm), was embedded in the subepicardial adipose tissue. ...
Interatrial block (IAB), is caused by abnormal conduction over the Bachmann's bundle and is associated with development of atrial tachyarrhythmias, most commonly atrial fibrillation. It also represents a risk factor for systemic thromboembolic events due to abnormal left atrial contraction. Additionally, delay of post operative P wave duration may, most of the times, induce atrial fibrillation. Moreover, it is well known that impaired blood supply to the sinus node and Buchman fibers due to pre-existing chronic sinus node artery ischemia may be considered as a risk factor of atrial fibrillation (AF). This case report shows that in a patient with pre-existing impaired sinus node artery blood supply in the preoperative coronary angiogram, one month after coronary bypass surgery may lead to post-operative IAB and atrial fibrillation. We also discuss the importance of atrial blood supply, possible preventive intervention and some considerations regarding anticoagulation treatment initiation.
... The artery that supplies the Sino-Atrial node was a branch of either the right or the left coronary artery. Most frequently (in 63% of cases), the SA node artery was the first anterior atrial branch of the right coronary artery (Fig. 1), originating at a distance of 1.2 cm (range 0.2 -2.2 cm) from the beginning of this vessel (17). It was usually the largest atrial branch of the right coronary artery; The initial part of the artery (1 -2 cm) was embedded in the subepicardial adipose tissue. ...
... Developing AV blocks in the setting of AMI is specifically related to an involvement of the AV nodal branch, that supplies the AV node. This branch might show significant variations in its origin: in 85-90% of individuals it arises from the right coronary artery (RCA), either from the proximal posterolateral branch (77%), or from the distal posterolateral branch (2%), or directly from the distal RCA (10% of cases) [3,4]. In a lower number of patients (about 6-7%) it may originate from the posterior descending artery (branch of the RCA or of the left coronary artery, LCA) or from the distal circumflex branch of the LCA (approximately 3-4%) [3]. ...
Acute coronary syndromes (ACS) might be complicated by atrioventricular (AV) and
intraventricular (IV) blocks in a significant number of cases, and often
represent a diagnostic and a therapeutic challenge. These conduction disturbances
are predictors of adverse prognosis, with complete AV blocks presenting the most
severe outcomes, showing an increased in-hospital mortality. With the advent of
emergency percutaneous coronary intervention (PCI) and the end of the
thrombolysis era, the incidence of both AV and IV blocks has surely decreased,
but their prognosis in this setting still remains a matter of debate. The aim of
this review is to evaluate the current knowledge on AV and IV blocks in the AMI
setting with or without ST segment elevation.
