جستجوی مقالات مرتبط با کلیدواژه « coronary sinus » در نشریات گروه « پزشکی »

Cardiac protection strategies in different methods are challenging and crucial, affecting postoperative morbidity and mortality.

We compared the cardio-protective effect of two cardioplegia solutions based on coronary sinus lactate levels.

 This randomized, double-blinded clinical trial study was performed on 46 candidates for mitral valve replacement between June 2020 and January 2021. The patients were categorized via block randomization

1) St. Thomas I cardioplegia (n=23) and St. Thomas Ⅱ cardioplegia (n=23). The coronary sinus lactate levels at different times were measured. In addition, some intra-operative and clinical characteristics after cardiac surgery were recorded. Data were analyzed in SPSS software (version 26.0) using paired and independent t-tests, repeated measure ANOVA, and Pearson correlation test at a significance level of P < 0.05.

In the time trend, the lactate levels in patients with St. Thomas Ⅱ cardioplegia solution had a significantly lower rate than in St. Thomas I (P=0.001). The two groups displayed no statistical difference between the aortic cross-clamp time (P=0.069) and the CPB time (P=0.091). Furthermore, the weaning from mechanical ventilation (P=0.078) and ICU stay (P=0.061) demonstrated no statistical difference between the study groups.

Based on significantly lower measures of the coronary sinus lactate, the St. Thomas Ⅱ cardioplegia solution showed a better cardio-protective effect in patients undergoing mitral valve surgery.

We herein describe a 34-year-old woman with a persistent left superior vena cava (PLSVC) impinging on the posterior wall of the left atrium, subdivided by a membrane at the distal part of the impingement. In this patient, a much dilated coronary sinus due to the PLSVC resulted in a membrane-like structure in the posterior wall of the left atrium with the appearance of the cor triatriatum in transthoracic echocardiography (ie, a pseudo cor triatriatum). Although the PLSVC is a common malformation of the superior systemic vein, its aforementioned presentation is rare.

Hyperglycemia during coronary artery bypass graft surgery (CABG) strongly predicts intra- and post-operative adverse consequences.

This study aimed to evaluate the quality of glycemic management during CABG in an academic center regarding peripheral blood and coronary sinus values.

This prospective descriptive study encompassed 55 eligible patients undergoing on-pump CABG surgery in 2020. Peripheral blood glucose (BG) was measured four times, before anesthesia induction (T0), before cardiopulmonary bypass pump (CPB) (T1), during CPB (T2), at the end of CPB (T3), and at the end of surgery (T4). The surgeon also took a sample of the coronary sinus BG.

The BG variations from T0 to T4 were statistically significant (P < 0.0001). The higher values detected in the ASA class III compared to ASA classes II were statistically significant at T1 (P = 0.01) and T2 (P = 0.025): patients with the higher BMI showed the higher levels of BG. In this regard, the differences were significant at T0 (P = 0.0001), T2 (P = 0.004), and T3 (P = 0.015). Regarding coronary sinus, the mean BG was 222.18 ± 75.74 mg/dL. It was also observed that the ASA class III (P = 0.001), longer duration of CPB (P = 0.021), higher IV fluid volume administrated during surgery (P = 0.023), higher BMI (P = 0.0001), and less urine volume at the end of surgery (P = 0.049) were significantly associated with the higher BG of the coronary sinus.

The existing glycemic management protocols on the CABG patients were acceptable in our hospital. However, the BG level of the coronary sinus was higher than the peripheral one.

Coronary sinus dimension is an important factor for diagnosing some types of cyanosis as well as congenital heart diseases and insertion of some devices into the coronary sinus if required. This study was designed to access the diameter and Z-score of the coronary sinus among children under 18 years of age.

In this cross-sectional study on 95 individuals, the coronary sinus diameter was measured by transthoracic echocardiography in the four-chamber view at the connection to the right atrium, middle part, and distal end. The linear regression equation was utilized to determine age-adjust reference values, Z-scores, and the relationship between the individuals’ coronary sinus diameter age, height, and body surface area. The study was conducted from March to July 2020 in Namazi hospital clinic of Shiraz University of Medical Sciences, Shiraz, Iran.

The mean age of the persons who entered this study was 5.87±4.25 years. The mean coronary sinus diameter was 4.91±1.29 mm at the site of connection to the right atrium, 4.50±1.44 mm at the middle part, and 3.74±1.32 mm at the distal end. Coronary sinus diameter correlates positively with the participants’ age, weight, height, and body surface area (P<0.001).

Coronary sinus diameter significantly correlates with the age, height, and body surface area of the cases. These features are useful in diagnosing some congenital heart diseases and insertion of suitable devices through it.

Coronary artery anomalies are reported to have a higher incidence in young victims of sudden cardiac arrest (4-15%), as compared to adults (1%). Among coronary anomalies, anomalous coronary artery arising from the opposite sinus of Valsalva (ACAOS) remains a major clinical problem which poses daunting challenges. The current paper reports on the first case with main left coronary anomalies with aortic failure due to the web sub-aortic. A 29-year-old woman with orthopnea referred to a doctor. Echocardiography and electrocardiogram (ECG) confirmed sub aortic web with severe aortic insufficiency. Subsequently, the patient was subjected to aortic valve replacement surgery and the subvalvular resection was performed. During the surgery, the aorta was initially opened and the left coronary hole was not found in the coronary sinus. Therefore, only a cardioplegia from the right coronary (artery) hole was administered to the patient. The cusps of the valve and subvalvular web were removed. During the release, the left main artery which apparently originated from the right coronary artery(RCA) was found to be damaged. Therefore, the damaged part of the left main coronary artery was repaired, the valve was placed, and the aorta was repaired. Following deaeration, cross-clamp was removed, and the right heart started to work; nonetheless, the left heart was not engaged in any activity. Therefore, the cross-clump was attached again to the aorta, and a vein graft on the left anterior descending (LAD) artery was placed on the aorta. After the removal of the cross-clamp, the heart recovered its normal function, and the patient was removed from the pump with low inotropic. Thereafter, she was transferred to the Intensive Care Unit (ICU) of open-heart surgery. The present report aimed to express the incidence of multiple complications, such as recurrence of illness, the optimal time for surgery, the best way of surgery, getting cardiologists' attention (colleagues) during angiography, and knowing the characteristics of these abnormalities.

Considering the many reports of elevated threshold levels and left ventricular dysfunction in epicardial leads, the evaluation of the short- and long-term efficacy of this type of leads is necessary in comparison with the coronary sinus (CS) leads. The present study compared left ventricular epicardial pacing via surgery and CS pacing in patients with triple- chamber pacemakers. This retrospective cohort study was performed on patients referred for cardiac resynchronization therapy. The patients were re-evaluated with ECG after pacemaker implantation and before discharge. The evaluations were performed in 2 patient groups under left ventricular epicardial pacing and CS pacing. At 12 months’ follow-up, the mean left ventricular pacing lead threshold was significantly higher in the patients with epicardial lead pacing than in those with endocardial lead pacing. Additionally, regarding the ECG pattern after lead pacing, the morphology of QRS at V1 lead and also the type of the QRS axis significantly differed between epicardial pacing and CS pacing 6–12 months after pacemaker implantation. The mean left ventricular pacing lead threshold was at its highest in the posterolateral area and at its lowest in the anterolateral area, but without any significant difference. Comparisons between the results and the long-term effects of CS pacing and surgical epicardial lead pacing in the present study indicated that the increase and changes in the left ventricular leading threshold in the epicardial pacing lead were much more pronounced than those in CS pacing through the CS. Therefore, the use of CS leads might be preferred to pericardial leads due to the stability of left ventricular leads.

The coronary sinus, whose electrical features play an important role in cardiac arrhythmias, is the integral part of the cardiac venous system. Here we describe a 67-year-old male patient with congestive heart failure who was referred to our hospital after the failure of the first cardiac resynchronization therapy defibrillator (CRT-D) implantation. During the cannulation of the coronary sinus, the separate orifice of the posterior cardiac vein was demonstrated by the retrograde filling of the coronary sinus via contrast injection into the posterior cardiac vein. Due to the serious tortuosity of the coronary venous sinus, a multipolar left ventricular lead was implanted using the separate ostium of the posterior cardiac vein. In our patient, the posterior cardiac vein directly drained into the right atrium. At 3 months’ follow-up with the CRT-D, he was asymptomatic (New York Heart Association functional class I).

In patients with cardiac resynchronization therapy (CRT), loss of left ventricular (LV) stimulation occurs chiefly because of LV lead dislodgement. The occurrence rate of LV lead dislodgement in different reports is between 2% and 12% of patients. LV lead dislodgement precludes clinical improvement. We describe 2 patients with heart failure, fulfilling the criteria for CRT implantation. In both patients, right ventricular and right atrial leads were implanted via the left subclavian vein in the right ventricular apex and the right atrial appendage, respectively. Repeated LV lead implantation was unsuccessful and each time after the fixation, the LV lead was dislodged with the heart motion during systole and diastole. In order to stabilize the LV lead, we decided to benefit from coronary sinus stenting and lead entrapment behind the deployed stent. LV lead stabilization was accomplished by the deployment of bare-metal stents (Multi-Link 3.5 × 8 mm and Multi-Link 3 × 8 mm, Abbott Vascular) in order to entrap the LV lead. The stents were deployed at a nominal pressure (10 atm). The pacing performance of the LV leads was satisfactory and stable at midterm in our experience. Stenting within the coronary sinus seems to be a safe method for LV lead stabilization and can substantially boost the success rate of CRT. Our device analysis during short- and midterm follow-up (4 months after implantation) revealed acceptable LV lead threshold and impedance.

We describe a patient with an asymptomatic complete unroofed coronary sinus (CS) syndrome associated with the CS stenosis in the absence of a persistent left superior vena cava (SVC) as identified on coronary computed tomography angiography. There was a large defect between the CS and the left atrium (i.e. a large left-to-right shunt), but an unusual combination of the absence of a persistent left SVC (i.e. no risk for brain abscess due to the absence of a right-to-left shunt) and the CS stenosis (i.e. a markedly reduced degree of a left-to-right shunt), resulting in an asymptomatic presentation.

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. Patients with this condition are usually asymptomatic. However, cardiac failure may occur later in life due to progressive enlargement of the fistula. Diagnosis is traditionally made by echocardiogram and conventional angiogram. However with the advantage of new technologies such as computed tomography (CT) coronary angiography, the course and communications of these fistulae can be delineated non-invasively and with greater accuracy. We report a case of a left circumflex artery fistula to the coronary sinus which was suspected on echocardiogram and the diagnosis was clinched on ECG-gated CT.

A 48-year-old male with a history of secundum type atrial septal defect (ASD) closure in childhood presented to our outpatient clinic complaining of palpitation for six months. Interestingly, transthoracic and transesophageal echocardiography exams showed an undiagnosed partially unroofed coronary sinus associated with persistent left superior vena cava (LSVC) and Cor triatriatum..

The coronary sinus (CS) blood flow can be used as a non-invasive measure of cardiac perfusion. Besides transesophageal echocardiography, transthoracic echocardiography with Doppler flow measurement has been introduced as a feasible and reproducible method to determine the CS blood flow. The purpose of this study was to assess the coronary flow reserve (CFR) by transthoracic imaging of the CS flow in patients with coronary artery disease before and after coronary artery bypass graft surgery (CABG). Twenty-nine patients with coronary artery disease who were candidates for CABG were evaluated in this study. CFR was measured using the CS flow profile. Twenty-one patients, comprised of 15 men and 6 women at a mean age of 56.7 ± 9.1 years, were evaluated. All the patients had a pre-operative increase in their coronary blood flow during the dipyridamole stress test (mean CFR/beat=1.38±0.2, mean CFR/min=1.54±0.18). CFR was significantly higher in post-operative status (mean CFR/beat=2.25±0.45, mean CFR/min=2.55±0.43, p <0.001). Our study, in accordance with previous studies, denotes that a transthoracic measurement of CFR can be used as a feasible and reproducible method to monitor the changes in cardiac perfusion after revascularization