Predicting Interatrial Septum Rotation: Is the Position of the Heart or the Direction of the Coronary Sinus Reliable?

Sun, Huan; Wang, Yanjing; Zhang, Zhenming; Liu, Lin; Yang, Ping

doi:10.1111/pace.12590

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…Как уже указывалось выше, для определения направления иглы для пункции МПП может быть использован такой ориентир, как катетер в КС. Однако, необходимо подчеркнуть, что в доступной литературе лишь немногими была изучена взаимосвязь между МПП и КС [11,12]. В нашей работе было впервые изучено взаимоотношение этих анатомических структур у пациентов, которым в последующем выполнялась КБИ УЛВ.…”

Section: обсуждение полученных результатовunclassified

“…Fender et al (2014) [17], средний угол МПП составил 60,6±10,6°, с разбросом от 29,5° до 88,7°. В исследовании H. Sun et al (2015) [11], приводятся следующие результаты: средний угол МПП составил 36,8±7,3° с минимальным значением в 19,1° и максимальным в 53°. Стоит отметить, что в последнее исследование были включены пациенты без какой-либо сердечно-сосудистой патологии, что могло сказаться на конечных результатах.…”

Section: обсуждение полученных результатовunclassified

“…Тем не менее, только в нескольких, доступных в международных базах данных, работах была изучена взаимосвязь положения МПП и направления КС. Так, H. Sun et al (2015) обнаружили статистически значимую корреляцию между положением МПП и направлением КС (r = 0,928; P <0,01) [11]. Однако, в этой работе изучались только пациенты с нормальным сердцем и без фибрилляции предсердий (ФП), а взаимосвязь МПП и КС была оценена только в аксиальной плоскости.…”

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Coronary sinus as an anatomical landmark for atrial transseptal puncture

Votyakov,

Didenko,

Menkov

et al. 2023

Vestnik aritmologii

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Aim. The study of interatrial septum (IAS) and coronary sinus (CS) syntopia in patients with atrial fibrillation (AF), who subsequently underwent pulmonary vein isolation with a cryoballoon and the determination of anatomical landmarks for puncture of the IAS.Methods. The data of preoperative computed tomography of the heart of 25 consecutive patients with AF, who subsequently underwent pulmonary vein isolation with a cryoballoon, were analyzed. Angulations describing IAS orientation and CS direction were measured. The relationships between IAS orientation, CS direction and size of left atrium were subsequently analyzed.Results. The mean angulations for IAS orientation and CS direction were 47.2±7.8° (range 27.6 - 57.3) and 47.2±7.8° (range 26.7 - 59.3) respectively. On the conventional clock face (direction of the flag of the puncture needle), these values corresponded to the following time: 4 h 34 min±15 min (from 3 h 55 min to 4 h 55 min) for the IAS orientation and 4 h 31 min±16 min (from 3 h 53 min to 4 h 54 min) for the CS direction. Statistically significant correlation was revealed between the IAS orientation and the CS direction (r = 0.77; p <0.001). Linear regression analysis by the least squares method showed that the CS direction explains 60% of the observed variability in IAS orientation. The final regression equation for the relationship between the IAS orientation and the CS direction is presented as: IAS orientation = 12.76 + 0.75 × CS direction. Analysis of the relationship between the IAS orientation and the size of the left atrium did not reveal any significant correlation and dependence (p=0.84). All 25 patients who took part in the study underwent pulmonary vein isolation with a cryoballoon. Puncture of the IAS from the first time was successful in 100% of patients. In 24 patients (96%), it was possible to achieve grade 4 occlusion of the pulmonary veins, and a bidirectional block was confirmed when checking the electrical activity of PV. All cryoballoon ablation procedures were completed without complications.Conclusion. In patients with AF, the CS direction can be a reliable predictor of the IAS orientation, which can be used in clinical practice. However, to verify the data and determine technical recommendations for transseptal puncture, additional clinical studies are needed.

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Section: обсуждение полученных результатовunclassified

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Coronary sinus as an anatomical landmark for atrial transseptal puncture

Votyakov,

Didenko,

Menkov

et al. 2023

Vestnik aritmologii

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“…CT exams were performed by a 320-section multi-detector row CT scanner (Aquilion; Toshiba America Medical Systems) [9] with the aid of iohexol (Isovue 370; Bracco Diagnostics, Inc) to enhance contrast (injected at 4-5 mL/sec into the antecubital vein). Scanning parameters were set as following: number of detector rows: 320; table feed per rotation: 7.2 mm; section thickness: 0.5 mm; tube voltage: 120 kVp; tube current: 400 mA; gantry rotation time, 400 msec.…”

Section: Protocol Used For Ct Scanmentioning

confidence: 99%

Revisiting right anterior oblique projections for the triangle of Koch: implications from computed tomography

Wang

Lin

Lakin

et al. 2020

BMC Cardiovasc Disord

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Background: Variability in the anatomy and orientation of the triangle of Koch (TK) complicates ablation procedures involving the atrioventricular (AV) node. We used CT angiography (CTA) to assess the anatomical TK orientation, the CS ostium direction, and the relationship between the two, and we validated an individualized CSguided projection during ablation procedures. Methods: In 104 patients without structural heart disease undergoing computed tomography (CT) angiography, TK orientations were determined in relation to the coronary sinus ostium (CSo) as well as two standard right anterior oblique (RAO) projection angles (30 o and 45 o) commonly used in ablation procedures. Results: A CS-guided RAO projection (RAOCS) was shown to best track the orientation of the TK compared to RAO30°and 45°, with TK orientation strongly correlating with the CSo direction (r = 0.86, P < 0.001). In addition, the mean relative difference between the angle of the CSo and TK orientation was 5.54 ± 0.48°, consistent with a reduction in the degree of image shortening compared to traditional RAOs. Moreover, in vivo validation following ablation revealed that using a CS-guided projection limited the degree of on-screen image shortening compared to both the RAO30°and 45°in 25 patients with catheter ablation procedures. Conclusion: In hearts with a normal structure, the CSo direction offers a reliable predictor of the TK orientation which can be used to guide the projection of the TK during ablation procedures.

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