The behavior of three types of large sinus node arteries with regard to the blood supply of the atrial myocardium

Abstract

Purpose

We describe angiographic findings of sinus node arteries (SNAs), focusing in the large sinus node artery (LSNA) variants, regarding the blood supply of the SN and atrial myocardium.

Methods

We examined the SN arteries via postmortem angiographic visualization in six hundred hearts derived from victims of various accidents.

Results

The main stem or a branch of the SNA supplied the right atrium (RA) and part of the interatrial septum (IS) in 32% of cases (Group A), one atrium, the IS and a small part of the other atrium (Group B) in 39% and the entire atrial myocardium (LSNAs) (Group C) in 29%. Forty-two percent (42%) of LSNAs were arising from the anterior part of the right coronary artery (RCA) (type 1), 9% from its intermediate part (type 2) and 49% from the posterolateral portion of the left circumflex artery (LCx) (type 3). Type 2 can be injured by surgical procedures, type 3 by interventional ones, while type 1 is not affected by any. The SN area was supplied in Groups A and B by the main stem of SN arteries in 370 cases (62%) and by branches (Br) in 55 (9%). The 175 cases of group C (29%) were supplied only by branches. The clockwise (40% of cases) and counterclockwise rotations (60%) of the SNA around the superior vena cava, concern surgical procedures.

Conclusion

The above findings are essential for every day surgical and interventional procedures.

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References

  1. 1.

    Anderson RH, Razavi R, Taylor AM (2004) Cardiac anatomy revisited. J Anat 205:159–177

    Article  Google Scholar 

  2. 2.

    Berdais D, Patonay L, Turina MI (2003) The clinical anatomy of the sinus node artery. Ann Thorac Surg 76:732–736

    Article  Google Scholar 

  3. 3.

    Boppana VS, Castaño A, Avula UMR, Yamazaki M, Kalifa J (2011) Atrial coronary arteries: anatomy and atrial perfusion territories. J Atr Fibril 4:375

    Google Scholar 

  4. 4.

    Davies MJ, Pomerance A (1972) Quantitative study of aging changes in the human sinoatrial node and internodal tracts. Br Heart J 34:150–152

    CAS  Article  Google Scholar 

  5. 5.

    Gaudino M, Nasso G, Minati A, Salica A, Luciani N, Morelli M, Gianfederico P (2003) Early and late arrhythmias in patients in preoperative sinus rhythm submitted to mitral valve surgery through the superior septal approach. Ann Thorac Surg 75:1181–1184

    Article  Google Scholar 

  6. 6.

    Gavrielatos G, Nerantzis CE (2011) Post mortem coronary angiographic visualization of a rare sinus node artery, anatomical variant. Hellenic J Cardiol 52:84–85

    PubMed  Google Scholar 

  7. 7.

    Haissaguerre M, Jais P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in pulmonary veins. N Engl J Med 339:659–666

    CAS  Article  Google Scholar 

  8. 8.

    Halon DA, Sapoznikov D, Lewis BS, Gotsman MS (1983) Localization of lesions in the coronery circulation. Am J Cardiol 52:921–926

    CAS  Article  Google Scholar 

  9. 9.

    Huntcinson MCE (1978) A study of the atrial arteries in man. J Anat 125:39–54

    Google Scholar 

  10. 10.

    James TN, Burch GE (1958) The atrial coronary arteries in man. Circulation 17:90–98

    CAS  Article  Google Scholar 

  11. 11.

    James TN (1973) The sinus node as a servomechanism. Cir Res 32:307–313

    CAS  Article  Google Scholar 

  12. 12.

    Mori S, Spicer DE, AndersonRH, (2016) Revisiting the anatomy of the living heart. Circ J 80:24–33

    Article  Google Scholar 

  13. 13.

    Nerantzis C, Avgoustakis D (1980) An S-shaped atrial artery supplying the sinus node. An anatomical study. Chest 78:274–278

    CAS  Article  Google Scholar 

  14. 14.

    Nerantzis CE, Toutouzas P, Avgoustakis D (1983) The importance of the sinus node artery in the blood supply of the atria myocardium. An anatomical study of 360 cases. Acta Cardiol 38:35–47

    CAS  PubMed  Google Scholar 

  15. 15.

    Nerantzis CE, Marianou SK, Koulouris SN, Agapitos EB, Papaioannou JA, Vlahos LJ (2004) Kugel’s artery: an anatomical and angiographic study using a new technique. Tex Heart Inst J 31:267–270

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Nerantzis CE, Gavrielatos G, Lefkidis CA, Koutsaftis PN (2009) A secret pathway of the sinus node artery. Foren Sci Int 186:e25-26

    Article  Google Scholar 

  17. 17.

    Nerantzis CE, Anninos H, Koutsaftis PN (2010) Variation in the blood supply of the sinus node. Surg Radiol Anat 32:983–984

    Article  Google Scholar 

  18. 18.

    Nerantzis CE, Koulouris S, Pastromas S (2011) Sinus node artery originating from the posterior part of the right coronary artery. Surg Radiol Anat 33:373–375

    Article  Google Scholar 

  19. 19.

    Nerantzis C, Bouzianis S, Theocharis S (2017) A long sinus node artery with an unusual origin and course. A case report. Eur J Anat 21:161–163

    Google Scholar 

  20. 20.

    Pappone C, Oreto G, Rosanio S et al (2001) Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 104:2539–2544

    CAS  Article  Google Scholar 

  21. 21.

    Pejković B, Krajnc I, Anderhuber F, Kosutić D (2008) Anatomical aspects of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human heart. J Int Med Res 36:691–698

    Article  Google Scholar 

  22. 22.

    Romhild DW, Hackel DB, Ester IH Jr (1968) Origin of blood supply to sinoauricular and atrioventricular node. Am Heart J 75:279–281

    Article  Google Scholar 

  23. 23.

    Schlesinger MJ (1940) Relation of anatomic pattern to pathologic conditions of the coronary arteries. Arch Path 30:403–415

    Google Scholar 

  24. 24.

    Utley JR, Leyland SA, Nguyenduy T (1995) Comparison of outcomes with three atrial incisions for mitral valve operations. J Thorac Cardiovasc Surg 109:582–587

    CAS  Article  Google Scholar 

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Acknowledgement

The authors thank the Hellenic Heart Foundation for its technical support.

Funding

The authors received no funding related to the conduction of this study.

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Authors

Contributions

CEN: protocol/project development, manuscript writing/editing, data analysis. HA: manuscript writing/editing, data analysis. SKM: data collection or management. SP: data collection or management.

Corresponding author

Correspondence to Hector Anninos.

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The authors have no conflicts of interest/competing interests to disclose.

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Angiographic images are available. No tissue samples exist

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Nerantzis, C.E., Anninos, H., Marianou, S.K. et al. The behavior of three types of large sinus node arteries with regard to the blood supply of the atrial myocardium. Surg Radiol Anat (2020). https://doi.org/10.1007/s00276-020-02621-5

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Keywords

  • Heart
  • Coronary arteries
  • Sinus node arteries
  • Atrial myocardium
  • Large sinus node arteries