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The arterial supply to the right atrium and the sinus node in classic tricuspid atresia
S A Battistessa1, S Y Ho, R H Anderson
1Guy's Hospital, London, England.
Insights
This study details the major arteries supplying the right atrium and sinus node in hearts with tricuspid atresia. Findings are crucial for understanding blood supply in complex congenital heart disease and Fontan procedures.
Area of Science:
- Cardiovascular Anatomy
- Congenital Heart Disease
- Surgical Anatomy
Background:
- Tricuspid atresia is a complex congenital heart defect requiring surgical intervention.
- Understanding the atrial and sinus node arterial supply is critical for surgical planning, particularly for the Fontan procedure.
Purpose of the Study:
- To identify and map the major arteries supplying the right atrium and sinus node in hearts with classic tricuspid atresia.
- To evaluate the origin and prevalence of these arteries.
- To discuss their relevance to surgical approaches like the Fontan procedure.
Main Methods:
- Dissection of 41 adult human hearts with classic tricuspid atresia.
- Detailed anatomical identification and documentation of atrial and sinus node arteries.
- Comparison of findings with normal cardiac anatomy.
Main Results:
- Right anterior atrial artery identified in 85.4%, right lateral in 68.3%, right posterior in 41.5%, and left anterior in 78.0%.
- Sinus node artery originated from the right coronary artery (38%), left coronary artery (59%), or had a dual origin (3%).
- Arterial distribution patterns were analyzed in relation to surgical incisions.
Conclusions:
- The study provides detailed anatomical data on atrial and sinus node arteries in tricuspid atresia.
- These findings have implications for optimizing surgical techniques and outcomes in the Fontan procedure.
- Knowledge of this vascular anatomy is essential for minimizing risks during cardiac surgery.
Abstract:
Dissection was performed in 41 hearts from patients with classic tricuspid atresia so as to demonstrate the major arteries supplying the right atrium and the sinus node. A right anterior atrial artery was identified in 85.4% of the hearts, a right lateral atrial artery was seen in 68.3%, a right posterior atrial artery in 41.5%, and a left anterior atrial artery in 78.0% of the specimens. The artery to the sinus node, identified in 34 hearts, originated from the right coronary artery in 38% of the cases, from the left coronary artery in 59%, and had a dual origin in 3% of cases. The relative importance of these arteries is discussed with regard to the atriopulmonary anastomosis of the Fontan procedure. Special consideration is given to the incisions employed in different variations of this operation and the arterial distribution is compared to that found in the normal heart.