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Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Anatomical variations of the coronary sinus valve (Thebesian valve): implications for electrocardiological procedures
Mateusz K Hołda1, Wiesława Klimek-Piotrowska2, Mateusz Koziej2
1Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, Kraków 31-034, Poland mateusz_holda@onet.eu.
Insights
The Thebesian valve (TV) is present in most hearts and can obstruct coronary sinus cannulation. However, only a small percentage of TVs significantly impede the procedure, with height inversely related to the coronary sinus ostium diameter.
Area of Science:
- Anatomy
- Cardiovascular Medicine
- Medical Imaging
Background:
- The Thebesian valve (TV) is an anatomical structure within the coronary sinus (CS).
- TV anatomy can present challenges during CS cannulation procedures.
- Understanding TV morphology is crucial for successful cardiac interventions.
Purpose of the Study:
- To investigate the anatomical features of the Thebesian valve (TV).
- To classify TV shapes and assess their potential to obstruct coronary sinus (CS) cannulation.
- To determine the relationship between TV morphology and CS ostium diameter.
Main Methods:
- Examination of 273 autopsied human hearts.
- Measurement of TV height and CS diameter.
- Classification of TV shapes into five types: remnant, semilunar, fold, cord, and mesh/fenestrated.
Main Results:
- The Thebesian valve was present in 82.1% of hearts.
- Semilunar (32.6%) and remnant (25.5%) were the most common TV types.
- Only 2.6% of TVs were obstructive; TV height was inversely correlated with coronary sinus ostium diameter (P < 0.001).
Conclusions:
- A novel classification for TV shapes is proposed based on the largest sample size to date.
- Obstructive Thebesian valves complicating cannulation are rare (2.6%).
- The inverse correlation between TV height and coronary sinus ostium diameter provides insights into cannulation success.
Aims:
The Thebesian valve (TV) can be a significant obstacle to coronary sinus (CS) cannulation. The aim of this study was to evaluate the characteristic features of the CS valve--TV anatomy. In particular, emphasis was placed on identifying specific structures of the TV that could potentially complicate CS cannulation.
Methods And Results:
We examined 273 autopsied human hearts. The height of the TV and the diameter of the CS were measured. The valves were classified according to their shape into five types: remnant, semilunar, fold, cord, and mesh and fenestrated. The mean transverse CS ostium (CSO) diameter was 12.2 ± 3.5 mm. The TV was present in 224 (82.1%) cases. The most common type of TV was semilunar: 32.6%; followed by remnant: 25.5%; fold: 17.4%; cord: 14.3%; and lastly mesh and fenestrated: 10.3%. The mean TV height for remnant-semilunar-fold types was 5.8 ± 3.0 mm. In seven cases, the present TV (2.6%) covered the entire orifice of the CS. Hearts with larger CSO diameter had lower TV height (P < 0.001).
Conclusions:
We propose a new classification of the TV shapes based on the largest sample to date. We assessed that only in 2.6% of all 273 cases the presence of an obstructive TV can cause unsuccessful cannulation. The height of the TV was inversely correlated to the CSO diameter (r = -0.33; P < 0.001).
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