Direct Injury to Right Coronary Artery in Patients Undergoing Tricuspid Annuloplasty

Díez‐Villanueva, Pablo; Gutiérrez‐Ibañes, Enrique; Cuerpo-Caballero, Gregorio P.; Sanz‐Ruiz, Ricardo; Abeytua, Manuel; Soriano, Javier; Sarnago, Fernando; Elı́zaga, Jaime; González-Pinto, Ángel; Fernández-Avilés, Francisco

doi:10.1016/j.athoracsur.2013.12.021

Cited by 44 publications

(31 citation statements)

References 20 publications

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“…Understanding if and where there are blood vessels inside the vestibule may greatly influence our approach to interventions. For instance, the right coronary artery may become damaged during ablation procedures (thermal injury, thrombosis) or during procedures that repair the right atrioventricular valve (direct injury, compression) 27,28 . On the other hand, it is also possible that the blood flow within the coronary vasculature may act as a heat sink and account for the local cooling of the right atrial myocardium, which in turn can reduce the effectiveness of ablation procedures.…”

Section: Discussionmentioning

confidence: 99%

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

Hołda

Słodowska

Tyrak

et al. 2020

Cardiovasc electrophysiol

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Introduction: The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures. Methods and Results: We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001). Conclusions: This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.

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Section: Discussionmentioning

confidence: 99%

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

Hołda

Słodowska

Tyrak

et al. 2020

Cardiovasc electrophysiol

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“…In its further course, the right coronary artery circumscribes the anterior and posterior portion of the annulus (11,26) which exposes it to a risk of compression, kinking or occlusion during annuloplasty procedures, especially when located close to the hinge point of the TV leaflets. Although no data exist, a distance of <2 mm has been suggested as a possible cut-off and is found in 13-28% of the patients (27,28).…”

Section: Morphology and Anatomical Relationsmentioning

confidence: 99%

Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

Winkel

Brugger

Khalique

et al. 2020

Front. Cardiovasc. Med.

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With the emergence of transcatheter solutions for the treatment of tricuspid regurgitation (TR) increased attention has been directed to the once neglected tricuspid valve (TV) complex. Recent studies have highlighted new aspects of valve anatomy and TR etiology. The assessment of valve morphology along with quantification of regurgitation severity and RV function pose several challenges to cardiac imagers guiding transcatheter valve procedures. This review article aims to give an overview over the role of modern imaging modalities during assessment and treatment of the TV.

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“…LAA morphology, ostial diameters and depth, the landing-zone as well as the presence of thrombi and the assessment of surrounding structures (pulmonary veins, mitral annulus, left circumflex artery) (95) should be managed in a multimodality fashion (96,97). CCTA can provide detailed information on the exact location and morphological characteristics of paravalvular leaks as common complication of surgical and interventional (98,99), including size, course and shape as well as the presence of multiple communications (100)(101)(102)(103)(104).…”

Section: Structural Interventional Cardiologymentioning

confidence: 99%

Cardiac CT angiography: normal and pathological anatomical features—a narrative review

Clemente

Seitun

Mantini

et al. 2020

Cardiovasc Diagn Ther

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The normal and pathological anatomy of the heart and coronary arteries are nowadays widely developed topics and constitute a fundamental part of the cultural background of the radiologist. The introduction of cardiac ECG-gated synchronized CT scanners with an ever-increasing number of detectors and with increasingly high structural characteristics (increase in temporal resolution, increase in contrast resolution with dual-source, dual energy scanners) allows the virtual measurement of anatomical in vivo structures complying with heart rate with submillimetric precision permitting to clearly depict the normal anatomy and follow the pathologic temporal evolution. Accordingly to these considerations, cardiac computed tomography angiography (CCTA) asserts itself as a gold standard method for the anatomical evaluation of the heart and permits to evaluate, verify, measure and characterize structural pathological alterations of both congenital and acquired degenerative diseases. Accordingly, CCTA is increasingly used as a prognostic model capable of modifying the outcome of diseased patients in planning interventions and in the post-surgical/interventional follow-up. The profound knowledge of cardiac anatomy and function through highly detailed CCTA analysis is required to perform an efficient and optimal use in real-world clinical practice.

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Direct Injury to Right Coronary Artery in Patients Undergoing Tricuspid Annuloplasty

Cited by 44 publications

References 20 publications

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

Topographical anatomy of the right atrial appendage vestibule and its isthmuses

Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

Cardiac CT angiography: normal and pathological anatomical features—a narrative review

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