Abstract: Recent developments in cardiac pacing and trans-coronary vein ablations
have demonstrated the increasing value of imaging of the cardiac
venous system (CVS), especially computed tomographic (CT) mapping
of the coronary veins. In contrast to that for coronary arteries, the literature
for coronary veins is scarce. Moreover, a complete, highly efficient,
and clinically useful classification of the CVS is not as straightforward
as for the coronary arteries. The CVS comprises polymorphous types
of venous conduits with notable anatomic variations. Recent anatomic
classification divides the cardiac veins into two main groups: tributaries
of the greater CVS and tributaries of the lesser CVS, consisting of
the thebesian vessels. The greater CVS is subdivided into two groups:
coronary sinus and non–coronary sinus tributaries. Imaging information
about the CVS in this review is useful for a better understanding of the
spatial orientation of the CVS and furthers proper use of the correct nomenclature
for this important system. The authors describe the clinical
implications of the different imaging techniques for assessment of the
coronary veins, where cardiac CT venous mapping has major advantages.
The role of CT in anatomic classification, assessment of anatomic
variants, and diagnosis of pathologic changes of the CVS is discussed.
The authors also underscore the particular role of CT venous mapping
for cardiac interventions, especially for left ventricular pacing in cardiac
resynchronization therapy and in percutaneous mitral annuloplasty.
Abstract: As a result of the numerous clinical and surgical data accumulated so far, the classical image of the mitral valve-a bicuspid valve, with two leaflets and two papillary muscles-undergoes significant modifications. The valve, included into the larger concept of the mitral valvular complex unveils numerous important valences and characteristics, among which, some represent newer concepts, of clinical and surgical significance: the valvular complex is a subtle and finely-tuned system of elements acting in a coordinated manner; the mitral valve is an active valve and not a mere passive flap bordering the atrioventricular junction. Not least, the mitral valve contributes to the make up and function of the left ventricular outflow tract. The anatomical and functional interdependence between the mitral valve and the left ventricular myocardium is evident not only following their particularities of vascularization but also it is reflected in morbid states such as ischemic cardiac disease and dilated cardiomyopathy. All the new concepts and ideas, ask for a more profound study of the clinical anatomy of the mitral valve, underscoring the importance of a pertinent dialogue between specialists and by using a more appropriate and unitary terminology.
Abstract: Upper limb arterial variations are frequently discovered at cadaver dissection, in
clinical or surgical settings. We report the case of a female patient with acute upper limb
ischemia due to a thrombosed brachial artery. At operation, an aberrant radial artery (ARA)
was found, resembling the brachial artery. Further identification of the brachial artery deep
to ARA leads to successful revascularization.
ª 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Abstract: The precise knowledge of regional anatomical details is of utmost importance specially in complex procedures such as the Ross operation. This anatomical study offers a critical approach regarding the advantages, limits, and precautions for this procedure.
Abstract: Chiari anomalies in the human right atrium ostensibly are encountered rarely. There is only sporadic mention in the literature of these fenestrated, net-like valves of the inferior vena cava, coronary sinus, or various strands connecting these with other right atrial structures. The effects of such structural anomalies on heart function are unknown. We report here gross observations of the right atrial net from among 213 cadavers, 38 autopsied, and 11 fetal hearts. Histological and ultrastructural examination of inferior vena cava and coronary sinus valves demonstrated that only the anomalous coronary sinus valves contained cardiac muscle. Chiari anomalies typically have referred to perforations or tissue strands related to the inferior vena cava valve and possibly the coronary sinus valve. The anomaly commonly is cited as occurring in 2% of individuals, although there has been no study to support this. We observed Chiari malformations in 13.6% of the 213 cadaver hearts, and 10.5% of the autopsied hearts examined. Of these malformations, the coronary sinus valve was fenestrated most frequently. We propose the term "right atrial net" for "Chiari net," for anomalies involving valves of the inferior vena cava and coronary sinus, and strands within the right atrium connecting these valves with the crista terminalis, right atrial wall, or interatrial septum.
Abstract: This new atlas represents a fresh fresh approach to cardiac anatomy, providing images of unparalleled quality, along with explanatory text, to show in vivo heart anatomy and explain the clinically relevant underlying anatomic concepts. In spite of amazing proliferation of information on the Internet and multiple websites filled with up-to-date information, there is no similarly detailed and systematic compilation of morphological imaging with CT. Organized for both systematic learning and to serve as a quick, yet detailed reference for specific clinical questions, this book is an invaluable resource for medical students and residents, cardiologists, and especially surgeons, interventionalists and electrophysiologists, who depend on ever more detailed imaging support in order to successfully perform increasingly complex coronary and noncoronary structural interventions and other procedures.
