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Interatrial communication through the mouth of the coronary sinus

Published online by Cambridge University Press:  30 July 2009

Alison Knauth ,
Karen P. McCarthy ,
Sandra Webb ,
Siew Yen Ho ,
Sally P. Allwork ,
Andrew C. Cook  and
Robert H. Anderson
Alison Knauth
Affiliation:
The Children's Hospital, Boston, MA, USA
Karen P. McCarthy
Affiliation:
National Heart & Lung Institute, Royal Brompton Campus, Imperial College School of Medicine, London
Sandra Webb
Affiliation:
St George's Hospital Medical School, Anatomy and Developmental Biology, London
Siew Yen Ho
Affiliation:
National Heart & Lung Institute, Royal Brompton Campus, Imperial College School of Medicine, London
Sally P. Allwork
Affiliation:
Cardiac Unit, Institute of Child Health, University College, London, UK
Andrew C. Cook
Affiliation:
Cardiac Unit, Institute of Child Health, University College, London, UK
Robert H. Anderson*
Affiliation:
Cardiac Unit, Institute of Child Health, University College, London, UK
*
FRCPath, Cardiac Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK. Tel: 020 7905 2295; Fax: 020 7905 2324; Email: [email protected]
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Abstract

Objectives: We describe the structure of, and suggest an etiology for, the interatrial communication which can occur through the mouth of the coronary sinus. Based on the study of human embryos, we propose that the defect is best explained by dissolution of the wall of the coronary sinus adjacent to the left atrium, permitting shunting between the atriums through the right atrial orifice of the sinus. Background: An interatrial communication across the mouth of the coronary sinus defect was first described in 1965 by Raghib and colleagues, its existence being predicated on the basis of incomplete formation of the left “atriovenous fold”. Their hypothesis implies that the coronary sinus never develops, and thus the atrial septum itself is incomplete. Methods: We have studied the development of the coronary sinus in a series of human embryos. Based on this work, we present the anatomical findings in 6 specimens with varying degrees of dissolution of the walls of the coronary sinus, and ten specimens with isomerism of the right atrial appendages, in which the sinus has never been formed. Results: The coronary sinus defect is not a hole within the atrial septum, but a communication between the atriums through the mouth of the sinus. There was a range of defects in our series of specimens with usual atrial arrangement, extending from complete absence of the walls which normally separate the coronary sinus from the left atrium, to small fenestrations between this vessel and the left atrial cavity. In the hearts with isomerism of the right atrial appendages, however, we never observed an orifice of the coronary sinus. Thus, a coronary sinus defect cannot exist in this setting. Conclusions: Our findings indicate that the defect requires initial formation of the walls of the coronary sinus, but with subsequent dissolution of the wall adjacent to the left atrium. This produces a communication between the atriums through the mouth of the sinus.

Keywords

Unroofed coronary sinusatrial septal defectsleft sinus horn
Type
Original Articles
Information
Cardiology in the Young , Volume 12 , Issue 4 , July 2002 , pp. 364 - 372
Copyright
Copyright © Cambridge University Press 2002

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References

1.Raghib, G, Ruttenberg, HD, Anderson, RC, Amplatz, K, Adams, P Jr, Edwards, JE.Termination of left superior vena cava in left atrium, atrial septal defect, and absence of coronary sinus. Circulation 1965; 31: 906–918.Google Scholar
2.Chauvin, M, Shah, DC, Haissaguerre, M, Marcellin, L, Brechenmacher, C.The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans. Circulation 2000; 101: 647–652.CrossRefGoogle ScholarPubMed
3.Rose, AG, Beckman, CB, Edwards, JE.Communication between coronary sinus and left atrium. Br Heart J 1974; 36: 182–185.Google Scholar
4.Quaegebeur, J, Kirklin, JW, Pacifico, AD, Bargeron, LM Jr. Surgical experience with unroofed coronary sinus. Ann Thorac Surg 1979; 7: 418–425.Google Scholar
5.Chen, MC, Hung, JS, Chang, KC, Lo, PH, Chen, YC, Fu, M.Partially unroofed coronary sinus and persistent left superior vena cava: intracardiac echocardiographic observation. J Ultrasound Medl 1996; 15: 875–879.CrossRefGoogle ScholarPubMed
6.Anderson, RH, Webb, S, Brown, NA.Clinical anatomy of the atrial septum with reference to its developmental components. Clin Anat 1999; 12: 362–374.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
7.Kawahito, T, Kitagawa, T, Hori, T, Chikugo, F, Shimoe, Y, Katoh, I.Surgical experience of two different types of unroofed coronary sinus. Nippon Kyobu Geka Gakkai Zasshi 1996; 44: 1015–1021.Google ScholarPubMed
8.Uemura, H, Ho, SY, Anderson, RH et al. , The surgical anatomy of coronary venous return in hearts with isomeric atrial appendages. J Thorac Cardiovasc Surg 1995; 110: 436–444.CrossRefGoogle ScholarPubMed
9.Watanabe, H, Hayashi, JI, Sugawara, M, Yagi, N.Complete unilateral anomalous connection of the left pulmonary veins to the coronary sinus with unroofed coronary sinus syndrome: a case report. Thorac Cardiovasc Surg 1999; 47: 193–195.CrossRefGoogle Scholar
10.Li, J, Al Zaghal, AM, Anderson, RH.The nature of the superior sinus venosus defect. Clin Anat 1998; 11: 349–352.3.0.CO;2-J>CrossRefGoogle ScholarPubMed