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Anatomical Science International

Erschienen in:

01.03.2014 | Original Article

Obstructive Thebesian valve: anatomical study and implications for invasive cardiologic procedures

verfasst von: Sanjib Kumar Ghosh, Shashi Raheja, Anita Tuli

Erschienen in: Anatomical Science International | Ausgabe 2/2014

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Abstract

Thebesian valve is the embryological remnant of the right sinoatrial valve, guarding the coronary sinus (CS) ostium. Advanced invasive and interventional cardiac diagnostic and management tools involve cannulation of the CS ostium. The presence of obstructive Thebesian valves has been reported to lead to unsuccessful cannulation of the CS. We studied the morphology of the Thebesian valve and CS ostium to assess the possible impact of these structures on invasive cardiological procedures. One hundred fifty randomly selected human cadaveric heart specimens fixed in 10 % formalin were dissected in the customary routine manner. The Thebesian valves were classified according to their shape as semilunar/fenestrated/biconcave band like and according to their composition as membranous/fibromuscular/fibrous/muscular, and the extent to which the valve covered the CS ostium was also noted. An obstructive Thebesian valve that could interfere with the cannulation of the CS was defined as non-fenestrated (semilunar/biconcave band like) and non-membranous (fibromuscular/fibrous/muscular) valves covering >75 % of the CS ostium. Thebesian valves were present in 118 (79 %) heart specimens, of which 27 (18 %) met the criteria of being obstructive. Semilunar was the most common type of Thebesian valve in terms of shape and was observed in 65 (65/118; 55 %) hearts. This type was associated with the least mean craniocaudal (7.9 ± 0.6 mm) and mean transverse (6.25 ± 0.6 mm) diameters of the CS ostium. The mean craniocaudal diameter of the CS ostium (9.4 ± 2.1 mm) was significantly larger (p = 0.004) than the mean transverse diameter (7.15 ± 1.5 mm) in specimens with Thebesian valves, and the cranial margin of the CS ostium was free from any attachment of the Thebesian valve in all the types observed (in terms of shape). Hence, attempts to direct the tip of the catheter toward the cranial margin of the CS ostium under direct vision may lead to successful cannulation of the same when conventional techniques have been unsuccessful because of the presence of an obstructive Thebesian valve.

Abraham WT (2003) Cardiac resynchronization therapy: a review of clinical trials and criteria for identifying the appropriate patient. Rev Cardiovasc Med 4:S30–S37

Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E (2002) Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845–1853PubMedCrossRef

Anh DJ, Eversull CS, Chen HA, Mofrad P, Mourlas NJ, Mead RH (2008) Characterization of human coronary sinus valves by direct visualization during biventricular pacemaker implantation. Pacing Clin Electrophysiol 31:78–82PubMedCrossRef

Bahru C, Schippel K (1990) Abnormal drainage of the middle cardiac vein (V. cordis media). Anat Anz 171(3):218–220PubMed

Bales GS (2004) Great cardiac vein variations. Clin Anat 17(5):436–443PubMedCrossRef

Bergman RA, Thompson SA, Saadeh FA (1988) Absence of coronary sinus. Anat Anz 166(1):9–12PubMed

Bhatnagar KP, Nettleton GS, Campbell FR, Wagner CE, Kuwabara N, Muresian H (2006) Chiari anomalies in the human right atrium. Clin Anat 19(6):510–516PubMedCrossRef

Cappato R, Schluter M, Weiss C, Willems S, Meinertz T, Juck KH (1997) Mapping of the coronary sinus and great cardiac vein using a 2-French electrode catheter and a right femoral approach. J Cardiovasc Electrophysiol 8:371–376PubMedCrossRef

Chitwood RW Jr (1988) Myocardial protection by retrograde cardioplegia: Coronary sinus and right atrium method. In: Cardiac Surgery: State of the art reviews. Hanley and Belfus, Philadelphia

Corcoran SJ, Lawrence C, McGuire MA (1999) The valve of Vieussens: an important cause of difficulty in advancing catheters into the cardiac veins. J Cardiovasc Electrophysiol 10:804–808PubMedCrossRef

Elwatidy A (2008) Coronary sinus injuries following retrograde cardioplesia. Asian Cardiovasc Thorac Ann 8:118–120CrossRef

Felle P, Bannigan JG (1994) Anatomy of the valve of the coronary sinus (thebesian valve). Clin Anat 7:10–12CrossRef

Fleisher AG, Sarabu MR, Reed GE (1994) Repair of coronary sinus rupture secondary to retrograde cardioplegia. Ann Thorac Surg 57(2):476–478PubMedCrossRef

Giebel J, Fanghanel J, Hauser S, Paul I (2000) A case of persistent left vena cava superior with atresia of the right atrial ostium of the coronary sinus. Ann Anat 182(2):191–194PubMedCrossRef

Hellerstein HK, Orbison JL (1951) Anatomic variations of the orifice of the human coronary sinus. Circulation 3:514–523PubMedCrossRef

Ishizawa A, Zhou M, Abe H (2007) Anomalous venous system in the human heart. Anat Sci Int 82(4):242–246PubMedCrossRef

Jha NK, Gogna A, Tan TH, Wong KY, Shankar S (2003) Atresia of coronary sinus ostium with retrograde drainage via persistent left superior vena cava. Ann Thorac Surg 76(6):2091–2092PubMedCrossRef

Karaca M, Bilge O, Dinckal MH, Ucerler H (2005) The anatomic barriers in the coronary sinus: implications for clinical procedures. J Interv Card Electrophysiol 14(2):89–94PubMedCrossRef

Katti K, Patil NP (2012) The Thebesian valve: gatekeeper to the coronary sinus. Clin Anat 25(3):379–385PubMedCrossRef

Kautzner J (2009) Thebesian valve: the guard dog of the coronary sinus? Europace 11:1136–1137PubMedCrossRef

Kawashima T, Sato K, Sato F, Sasaki H (2003) An anatomical study of the human cardiac veins with special reference to the drainage of the great cardiac vein. Ann Anat 185(6):535–542PubMedCrossRef

Krishnan SC, Tops LF, Bax JJ (2009) Cardiac resynchronization therapy devices guided by imaging technology. J Am Coll Cardiol Imaging 2:226–230CrossRef

Kshettry VR, Salerno CT, Lakhanpal S, Kroshus TJ (1996) Coronary sinus injury during retrograde cardioplegia: a report of three cases. J Card Surg 11(5):359–362PubMedCrossRef

Loukas M, Clarke P, Tubbs RS, Kolbinger W (2008) Adam Christian Thebesius, a historical perspective. Int J Cardiol 129:138–140PubMedCrossRef

Loukas M, Sullivan A, Tubbs RS, Weinhaus AJ, Derderian T, Hanna M (2010) Chiari’s network: review of literature. Surg Radiol Anat 32(10):895–901PubMedCrossRef

Mak GS, Hill AJ, Moisiuc F, Krishnan SC (2009) Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures. Europace 11:1188–1192PubMedCrossRef

Menasche P, Subayi JB, Piwnica A (1990) Retrograde coronary sinus cardioplegia for aortic valve operations: a clinical report on 500 patients. Ann Thoracic Surg 49:556–564CrossRef

Mlynarski R, Mlynarska A, Tendera M, Sosnowski M (2011) Coronary sinus ostium: the key structure in the heart’s anatomy from the electrophysiologist’s point of view. Heart Vessels 26(4):449–456PubMedCrossRef

Noble S, Vilarino R, Muller H, Sunthorn H, Roffi M (2011) Fatal coronary sinus and aortic erosions following percutaneous transvenous mitral annuloplasty device. EuroIntervention 7(1):148–150PubMedCrossRef

Parikh MG, Halleran SM, Bharati S, Trohman RG (2011) Successful percutaneous cardiac resynchronization despite an occlusive Thebesian valve. Pediatr Cardiol 32(8):1223–1227PubMedCrossRef

Pejkovic B, Krajnc I, Anderhuber F, Kosutic D (2008) Anatomical variations of the coronary sinus ostium area of the human heart. J Int Med Res 36(2):314–321PubMedCrossRef

Puglisi A, Lunati M, Marullo AG, Bianchi S, Feccia M, Sqreccia F (2004) Limited thoracotomy as a second choice alternative to transvenous implant for cardiac resynchronization therapy delivery. Eur Heart J 25:1063–1069PubMedCrossRef

Sack S, Kahlert P, Bilodeau L, Pierard LA, Lancellotti P, Lagrand V (2009) Percutaneous transvenous mitral annuloplasty: initial human experience with a novel coronary sinus implant device. Circ Cardiovasc Interv 2(4):277–284PubMedCrossRef

Saremi F, Pourzand L, Krishnan S, Ashikyan O, Gurudevan SV, Narula J (2008) Right atrial cavatricuspid isthmus: anatomic characterization with multi-detector row CT. Radiology 27:658–668CrossRef

Savage EB, Ferguson TB Jr, DiSesa VJ (2003) Use of mitral valve repair: analysis of contemporary United States experience reported to the society of thoracic surgeons national cardiac database. Ann Thorac Surg 75:820–825PubMedCrossRef

Shinbane JS, Girsky MJ, Mao S, Budoff MJ (2004) Thebesian valve imaging with electron beam CT angiography: implications for resynchronization therapy. Pacing Clin Electrophysiol 27:1566–1567PubMedCrossRef

Singh JP, Houser S, Heist EK, Ruskin JN (2005) The coronary venous anatomy: a segmental approach to aid cardiac resynchronization therapy. J Am Coll Cardiol 46(1):68–74PubMedCrossRef

Strohmer B (2008) Valve of Vieussens: an obstacle for left ventricular lead placement. Can J Cardiol 24(9):e63PubMedCrossRef

Teo EY, Ittleman F, Hamlin M (2010) A Chiari Network and Difficult Cannulation of the Coronary Sinus for Retrograde Perfusion. Anesth Analg 111(1):79–81PubMed

Webb JG, Harnek J, Munt BI, Kimblad PO, Chandavimol M, Thompson CR (2006) Percutaneous transvenous mitral annuloplasty: initial human experience with device implantation in the coronary sinus. Circulation 113:851–855PubMedCrossRef

Titel: Obstructive Thebesian valve: anatomical study and implications for invasive cardiologic procedures
verfasst von: Sanjib Kumar Ghosh
Shashi Raheja
Anita Tuli
Publikationsdatum: 01.03.2014
Verlag: Springer Japan
Erschienen in: Anatomical Science International / Ausgabe 2/2014
Print ISSN: 1447-6959
Elektronische ISSN: 1447-073X
DOI: https://doi.org/10.1007/s12565-013-0203-0

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