Detailed radiological study of the patent ductus arteriosus: a computed tomography study in the Polish population

Background: The aim of the study was to perform qualitative and quantitative computed tomography (CT) angiography-based evaluation of patent ductus arteriosus (PDA) morphology and its influence on morphology of the great vessels. Materials and methods: Two-thousand twenty-two patients underwent 64-slice or dual-source CT and were retrospectively screened for the presence of PDA. Those who had presence of PDA underwent evaluation of its anatomy and morphology. Results: Thirty-two adult patients with PDA were evaluated (mean age 41.4 ± 17.4 years). Subjects with PDA had a higher value of aortic isthmus (p = 0.0148), main pulmonary artery (p < 0.0001), right (p =0.0007) and left (p = 0.0074) pulmonary arteries diameters than individuals from control group (16 adults, median age 43.3 ± 12.4 years). Types A, B, C, D, and E of PDA morphology occurred in 16 (50%), 3 (9%), 9 (28%), 2 (6%), and 2 (6%) patients, respectively. Subjects with the type A configuration of PDA tended to have a larger diameter at the aortic orifice (10.2 ± 5.2 mm vs. 6.4 ± 4.9 mm, p = 0.09) and a larger maximal diameter (10.3 ± 5.3 mm vs. 7.1 ± 4.7 mm, p = 0.14) compared to subjects with the type C configuration. The values of minimal, mean, and maximal diameters of PDA were 4.7 ± 1.9 mm, 7.0 ± 3.2 mm, and 9.4 ± 5.0 mm, respectively. The Spearman correlation coefficient between the main pulmonary artery and PDA diameters demonstrated a good correlation for minimal (r = 0.70, p < 0.001), mean (r = 0.62, p = 001), and maximal (r = 0.60, p = 0.0003) PDA diameters. Conclusions: Computed tomography enables quantitative and qualitative evaluation of PDA, including its type of morphology, length, and diameters. In the evaluated adult population with PDA, the majority of patients had dilation of the aortic isthmus and pulmonary arteries. PDA diameters correlate with diameters of the pulmonary arteries and this correlation is strongest between PDA diameter at the narrowest site and main pulmonary artery

The Thebesian valve and its significance for electrophysiologists

Background: Invasive cardiac procedures, such as arrhythmia ablation, cardiac resynchronisation therapy, percutaneous mitral annuloplasty and retrograde cardioplegia delivery require cannulation of the coronary sinus (CS). Detailed knowledge of the CS ostium region, including recognition of the presence of the Thebesian valve which sometimes covers the sinus, is a key to successfully carryout such procedures.Materials and methods: In the present study, 160 autopsied human hearts from both sexes were examined for the presence of the Thebesian valve. If identified, the histological structure of the valve was studied.Results: Five types of the CS valve were distinguished; all of them presented with a typical histological structure with the exception of the cord-like type, in which cells were similar to those of the conduction system of the heart.Conclusions: Proper identification of the CS valve and analysis of its size and histological features could have important implications for electrophysiologists

Variations of coronary sinus tributaries among patients undergoing cardiac resynchronization therapy

Background: In cardiac resynchronization therapy, the coronary venous system is used for left ventricular pacing electrode placement. Despite the well-known anatomy of the coronary sinus and its tributaries, heart failure patients' remodeled and enlarged left ventricles may impede the successful lead placement because of acquired anatomical obstacles. Materials and methods: Fifty-five patients qualified for cardiac resynchronization therapy treatment (CRT) were divided into ischemic and non-ischemic cardiomyopathy. Forty-four control groups without heart failure underwent dual-source computed tomography (CT). Rendered reconstructions of cardiac coronary systems were compared. Results: The presence of main tributaries was comparable in all groups. The left marginal vein, small cardiac vein, and oblique vein of the left atrium were present in 63%, 60%, and 51% of the hearts in all the groups. CRT referred CT's had significantly longer distances between posterior and lateral cardiac veins over the left ventricle (p < 0.05), wider angles of tributaries (p = 0.03), and smaller lumen of coronary sinus (p = 0.03). In the non-ischemic group, the posterior interventricular and great cardiac veins are more extensive than in the control group. Age-related analysis of vessel size shows a moderate correlation between age and diminishing mean vessel size in all the groups studied. Conclusions: The general structure of the coronary heart system is consistent in patients with and without heart failure. The variance of the general structure, or the presence of adequate veins, is an individual variation. The use of CT and analysis of the coronary veins allow better planning of the CRT-D implantation procedure and may reduce the risk of ineffective left ventricular electrode implantation