From cold-blooded reptiles to embryological remnants: Persistent myocardial sinusoids

Area of Science:

• Cardiovascular Imaging
• Cardiac Anatomy
• Medical Diagnostics

Background:

• Myocardial vascular patterns typically follow either a coronary or sinusoidal type.
• The sinusoidal pattern, characterized by direct ventricular blood supply via a spongy network, is observed in non-mammals and early human embryonic development.
• Persistent myocardial sinusoids are rare in adult warm-blooded animals.

Observation:

• A 61-year-old male with atrial fibrillation and severe tachymyopathy (LVEF 20%) underwent CT angiography for pulmonary vein assessment.
• Incidental finding of a myocardial defect with a tail-like extension into the right ventricle on CT.
• Cardiac MRI excluded myocardial infarction or fibrosis, and other imaging modalities ruled out a ventricular septal defect.

Findings:

• The imaging findings were consistent with a persistent myocardial sinusoid, a rare congenital anomaly.
• Computed tomography (CT) and cardiac magnetic resonance (CMR) were crucial for precise detection and differential diagnosis.
• A multi-colored 3D-printed model enhanced the visuospatial understanding of the anomaly.

Implications:

• This case underscores the utility of advanced imaging techniques (CT and CMR) in diagnosing rare myocardial anomalies in adults.
• Accurate diagnosis of persistent myocardial sinusoids is essential for appropriate clinical management and understanding of cardiac function.
• The use of 3D printing can aid in the visualization and educational appreciation of complex cardiac structures and pathologies.