IJCRR - 8(12), June, 2016
GROSS ANATOMICAL VARIATIONS IN THE THEBESIAN VALVE COVERING THE CORONARY SINUS OSTIUM: A CASE STUDY
Author: Anitha Thillai, Anjana TSR, Sivakami Thiagarajan
Objectives: The Coronary Sinus (CS) is a widely employed structure for cannulation during electrophysiologic procedures like catheter ablation of arrhythmias, implantation of resynchronization therapy devices and percutaneous mitral valve repair. The present study aims to evaluate the variations in the Thebesian valve covering the coronary sinus ostium.
Materials and Methods: The present study was conducted in randomly selected 100 human cadaveric hearts from the Department of Anatomy and autopsied bodies of Department of Forensic Medicine, Thanjavur Medical College. The presence or absence of Thebesian valve, shape of the valve, presence or absence of fenestrations in Thebesian valve were noted.
Results: The Thebesian valve was present in 84% and was absent in 16%.The shape of the valve was semicircular in 84.7%, strands in 8.3% and bands in7%.The valve was fenestrated in 20.2%. An interesting variation of double crescentic Thebesian valve was present in one specimen.
Conclusion: This study showed that the Thebesian valve was present in 84% of heart specimens. The prominent Thebesian valve or a fenestrated valve or a large band may be an under recognised problem interfering with cannulation. It may pose a significant challenge with regards to cannulation of coronary sinus ostium during various invasive procedures like catheter ablation for arrhythmias, implantation of resynchronization therapy devices and percutaneous mitral valve repair and coronary lead placement.
Keywords: Coronary sinus, Coronary sinus ostia, Thebesian valve, Cannulation
Anitha Thillai, Anjana TSR, Sivakami Thiagarajan. GROSS ANATOMICAL VARIATIONS IN THE THEBESIAN VALVE COVERING THE CORONARY SINUS OSTIUM: A CASE STUDY International Journal of Current Research and Review. 8(12), June, 35-38
1. Singh J.P, Houser S, Heist E.K, Ruskin J.N, The Coronary Venous Anatomy, A Segmental Approach to Aid Cardiac Resynchronization Therapy. American College of Cardiology J; 2005; 46:48-74.
2. Mak G. S, Hill A.J, Moisiuc F, Krishnan S.C, Variations in Thebesian valve anatomy and Coronary Sinus Ostium Implications for Invasive Electrophysiology Procedures Europace J;2009;11: 1188–1192.
3. Gray’s Anatomy, The Anatomical Basis of Clinical Practice, 40th Edition, Churchill Living Stone; 2008; 964,978-82.
4. Snell R.S, Clinical Anatomy by systems, Edition, Philadelphia, Williams and Wilkins; 2007: 145-147.
5. Willerson J.T, Cohn.Jn, Cardiovascular Medicine, NewYork, Churchill Livingstone; 1995; 55-58.
6. Grant B.J.C,A, Method of Anatomy Descriptive and Deductive, 6th Edition, Baltimore: Williams and Wilkins; 1959; 555-561.
7. Skandalakis J.E, Surgical Anatomy, The Embryologic and Anatomic Basis of Modern Surgery, 1stEdition,Paschalides Medical Publication; 2004; 305-07.
8. Sinnatamby C.S, Last’s Anatomy Regional and Applied, 11th Edition, Edinburg; Churchill Living Stone; 2006:206-213.
9. Hollinshead H.W, Anatomy for Surgeons Vol-2, 2nd Edition, New York: Harperand; 1966; 112-119,124,125.
10. Habib A, Lachman N, Kevin N, Christensen and Asirvatham S.J, The Anatomy of the Coronary Sinus Venous System for the Cardiac Electrophysiologist, Europace; 2009; vol 11:v15–v21.
11. Topol E.J, Text book of interventional cardiology 5th Edition, Philadelphia , Saunders.
12. Hellerstein H.K, Orbison J.L, Anatomic Variations of the Orifice of the Human Coronary Sinus Circulation, American Heart Association.J:1951; 3:514-523.
13. Karaca , M et al, The anatomic barriers in the coronary sinus: implications for clinical procedures. J Interv Card Electrophysiol. 2005;14:89–94.
14. El-Maasarany, et al, The Coronary Sinus Conduit Function: Anatomical Study (relationship to adjacent structures). Europace J.2005,7, 475-481.
15. Anh et al, Characterization of human coronary sinus valves by direct visualization during biventricular pacemaker implantation. Pacing Clin Electrophysiol J. 2008;31:78-82.