Variations in human pulmonary vein ostia morphology: A systematic review with meta‐analysis

Abstract

This study aimed to establish the most accurate and up‐to‐date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta‐analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left‐sided PVs have smaller ostia than the corresponding right‐sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta‐analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.

Slow blood-flow in the left atrial appendage is associated with stroke in atrial fibrillation patients

“…Existing studies have not considered area of PVs while assessing stroke risk for AF patients. Previously, Bonczar suggested that left sided PVs have smaller ostia than the corresponding right-sided PVs, and the inferior PVs ostia are smaller than the superior by meta-analysis [ 35 ]. Also, they found that the left common PV ostium size is the largest among all veins analyzed, while the right middle PV ostium is the smallest.…”

The anatomy of the atrioventricular nodal artery: A meta‐analysis with implications for cardiothoracic surgery and ablation procedures

“…Knowledge of such anatomical variations can eliminate potential risks while simultaneously aiding in the successful performance of arrhythmia treatments and invasive cardiothoracic procedures (Bonczar, Piątek‐Koziej, et al, 2022; Kuniewicz et al, 2022). This can prevent any dissection and permanent damage to the AVNA and the arterial network of the conduction axis.…”

Morphogenesis of the pulmonary vein and left atrial appendage in human embryos and early fetuses

“…However, the diameter of LIPV decreases as it approaches the LA (Kim et al, 2005). Moreover, the inferior PVs are smaller than the superior PVs (Bonczar et al, 2022). Our study's embryonic and fetal specimens showed a similar trend to the adult morphology in that the proximal cross‐section of the left PVs is flatter and smaller than that of the right PVs.…”