• Home
  • Aim of this blog

Dr.S.Venkatesan MD

Expressions in cardiology

Feeds:
Posts
Comments
« Corona second wave might bring some good news !
Why AF is often well tolerated in Hypertrophic cardiomyopathy ? »

ASD device closure: “Mind the gap” to avoid SA nodal artery compression.

November 20, 2020 by dr s venkatesan

The branching pattern of the human cardio-vascular tree is as unique as one’s fingerprint. One such hugely variable anatomy is the SA nodal blood supply.

Certain salient features

  • Variation can be seen in origin, course, and termination.
  • Now it is estimated to arise from RCA in 70% (Moved up from 55% in old studies )
  • From LCX (25%)
  • Dual SA node supply(5%)
  • Direct from Aorta

It is heartening to find this good anatomical review on this topic.

A) From the Right Coronary Artery; (B) From the Left Circumflex Artery (proximal); (C) From the Left Circumflex Artery (distal); (D) From the Left Coronary Artery; (E) From the Aorta; (F) Dual origin from the Right Coronary Artery and the Left Circumflex Artery. Image source : Vikse J, PLoS ONE 11(2): e0148331

Implication for the surgeon

The whereabouts of this tiny, yet important artery is critical to the surgeons’ as they incise and explore the atrial roof. (A gateway, that gives access to so many cardiac surgeries) The SA nodal artery mostly goes retro caval but it can be peri-caval or even anterior to SVC.

This image shows (a,b,c) the course in relation to SVC, Developmentally as the venous pole go posteriorly to fix the SA artery behind it.Image source : Vikse J, PLoS ONE 11(2): e0148331

For the Interventional cardiologist

A rare but distinct mechanical compression of SA node artery is reported with large ASD closure device. The plane of compression is usually occurring in the superior aspect of IAS when the SA node artery cross over the RA to reach the SA node. Should be suspected whenever unusual bradycardia occurs during the manipulation of the device or just after deployment. Always mind the delicate gap  between the antero superior rim and disc where SA nodal artery is likely to trespass.

AV node Ischemia with ASD device

With precise imaging modalities, new secrets are emerging. Additional AV node arteries from proximal RCA is documented.This is a surprising learning point for us. This artery is referred to as the right superior descending artery, which provides an alternative blood supply to the AV node from the proximal right coronary artery. The transient compromise of this hitherto unknown AV nodal twigs by the ASD device cause AV blocks. With this new info, we also got an answer to one more lingering question, why would disproportionate bradycardias are observed in inferior MI even when distal RCA is flowing well. We can’t blame high vagal tone always.

SA node compression by ASD device amplatzer

A CT angiogram showing how the ASD device encroaches the SA node artery. Image Source:Tsunehisa Yamamoto JACC 2016 (Linkedbelow)

The original article has an excellent video clipping of how an ASD device hugs the SA node at the superior edge of ASD.

Final message

Human anatomy is not the subject meant to be read in the first-year medical school cadavers, & forget thereafter. Surprisingly. the field of anatomy is also evolving with new mysteries exposed by modern imaging.SA nodal arterial blood supply is one such interesting aspect of cardiac anatomy. Young fellows in cardiology shall pursue further anatomical dark spaces in the heart (One such topic is how cardiac lymphatics compete with the venous system in draining cardiac interstitium)

Reference

Vikse J, Henry BM, Roy J, RamakrishnanPK, Hsieh WC, Walocha JA, et al. (2016) AnatomicalVariations in the Sinoatrial Nodal Artery: A Meta-Analysis and Clinical Considerations. PLoS ONE 11(2): e0148331

It’s gratifying a unique and committed group exclusively doing research in Anatomy. It Department of Anatomy, Jagiellonian University Medical College, Krakow Poland.

http://www.eba.cm.uj.edu.pl/

Rate this:

Share this:

  • LinkedIn
  • WhatsApp
  • Twitter
  • Facebook
  • Email

Related

Posted in Cardiology research topics, cardiology research topics for fellows, Uncategorized | Tagged ASD device closure, cardaic lymphatics, cardiology reserach topic, sa nodal compression during asd device closure |

  • Categories

  • Archives

    • April 2021 (3)
    • March 2021 (3)
    • February 2021 (6)
    • January 2021 (8)
    • December 2020 (4)
    • November 2020 (5)
    • October 2020 (7)
    • September 2020 (7)
    • August 2020 (10)
    • July 2020 (6)
    • June 2020 (9)
    • May 2020 (9)
    • April 2020 (5)
    • March 2020 (7)
    • February 2020 (3)
    • January 2020 (4)
    • December 2019 (4)
    • November 2019 (6)
    • October 2019 (3)
    • September 2019 (6)
    • August 2019 (3)
    • July 2019 (1)
    • June 2019 (3)
    • May 2019 (2)
    • April 2019 (2)
    • March 2019 (2)
    • February 2019 (4)
    • January 2019 (2)
    • December 2018 (2)
    • November 2018 (2)
    • October 2018 (2)
    • September 2018 (1)
    • August 2018 (2)
    • July 2018 (3)
    • June 2018 (1)
    • May 2018 (3)
    • April 2018 (1)
    • March 2018 (3)
    • February 2018 (3)
    • January 2018 (1)
    • December 2017 (3)
    • November 2017 (3)
    • October 2017 (3)
    • September 2017 (2)
    • August 2017 (2)
    • July 2017 (2)
    • June 2017 (2)
    • May 2017 (4)
    • April 2017 (3)
    • March 2017 (3)
    • February 2017 (5)
    • January 2017 (3)
    • December 2016 (2)
    • November 2016 (5)
    • October 2016 (4)
    • September 2016 (3)
    • August 2016 (5)
    • July 2016 (3)
    • June 2016 (4)
    • May 2016 (3)
    • April 2016 (6)
    • March 2016 (4)
    • February 2016 (3)
    • January 2016 (5)
    • December 2015 (6)
    • November 2015 (5)
    • October 2015 (8)
    • September 2015 (2)
    • August 2015 (5)
    • July 2015 (7)
    • June 2015 (4)
    • May 2015 (6)
    • April 2015 (5)
    • March 2015 (7)
    • February 2015 (15)
    • January 2015 (8)
    • December 2014 (5)
    • November 2014 (8)
    • October 2014 (7)
    • September 2014 (9)
    • August 2014 (5)
    • July 2014 (11)
    • June 2014 (5)
    • May 2014 (4)
    • April 2014 (5)
    • March 2014 (8)
    • February 2014 (8)
    • January 2014 (5)
    • December 2013 (7)
    • November 2013 (7)
    • October 2013 (14)
    • September 2013 (12)
    • August 2013 (15)
    • July 2013 (15)
    • June 2013 (15)
    • May 2013 (15)
    • April 2013 (15)
    • March 2013 (15)
    • February 2013 (15)
    • January 2013 (15)
    • December 2012 (15)
    • November 2012 (15)
    • October 2012 (15)
    • September 2012 (15)
    • August 2012 (15)
    • July 2012 (15)
    • June 2012 (15)
    • May 2012 (15)
    • April 2012 (15)
    • March 2012 (15)
    • February 2012 (15)
    • January 2012 (15)
    • December 2011 (15)
    • November 2011 (17)
    • October 2011 (17)
    • September 2011 (17)
    • August 2011 (21)
    • July 2011 (20)
    • June 2011 (17)
    • May 2011 (15)
    • April 2011 (17)
    • March 2011 (25)
    • February 2011 (20)
    • January 2011 (20)
    • December 2010 (18)
    • November 2010 (21)
    • October 2010 (21)
    • September 2010 (25)
    • August 2010 (20)
    • July 2010 (10)
    • June 2010 (11)
    • May 2010 (19)
    • April 2010 (16)
    • March 2010 (14)
    • February 2010 (22)
    • January 2010 (18)
    • December 2009 (20)
    • November 2009 (20)
    • October 2009 (3)
    • September 2009 (21)
    • August 2009 (19)
    • July 2009 (12)
    • June 2009 (12)
    • May 2009 (11)
    • April 2009 (15)
    • March 2009 (21)
    • February 2009 (4)
    • January 2009 (12)
    • December 2008 (13)
    • November 2008 (9)
    • October 2008 (22)
    • September 2008 (20)
    • August 2008 (16)
    • July 2008 (14)
    • June 2008 (7)
  • Blog Stats

    • 5,398,101 hits
  • Please give your feed back .

  • Click below to see who is watching this website live !

  • This site will never aim for profit. Still ,this donation link is added at the request of few visitors who wanted to contribute and of-course that will help make it sustainable . Donate Button with Credit Cards
  • Please Note

    The author acknowledges all the queries posted by the readers and wishes to answer them .Due to logistic reasons only few could be responded. Inconvenience caused is regretted.

WPThemes.


Cancel

 
Loading Comments...
Comment
    ×
    loading Cancel
    Post was not sent - check your email addresses!
    Email check failed, please try again
    Sorry, your blog cannot share posts by email.