© 2002 by European Society of Cardiology
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Anomalies of cardiac venous drainage associated with abnormalities of cardiac conduction system
1Department of Therapeutics and Pharmacology, Queen's University Belfast, Northern Ireland, U.K.; 2Department of Cardiology, Belfast City Hospital Northern Ireland, U.K.
The embryological development of the superior vena cava (SVC) is complex. If the left common cardinal vein fails to occlude it can, along with the left duct of Cuvier form a left SVC, which frequently drains into the coronary sinus. This may result in abnormalities in the anatomy of this structure. A persistent left SVC occurs in 0·5% of the normal population, and 3% to 4·3% of patients with congenital heart anomalies.
The pacemaking tissue of the heart is derived from two sites near the progenitors of the superior vena cava. The right-sided site forms the sinoatrial node, the left-sided site is normally carried down to an area near the coronary sinus.
Out of 300 patients with cardiac rhythm abnormalities, who have undergone electrophysiological studies (EPS), or permanent pacemaker insertion (PPI), we identified 12 patients with cardiac conduction abnormalities and anomalies of venous drainage. Anomalies of the coronary sinus may be associated with abnormalities of the conduction system of the heart. This may be due to the close proximity of the coronary sinus to the final position of the left-sided primitive pacemaking tissue. In our series of 300 patients, 4% had an associated left SVC, a similar incidence to that found in previous studies of congenital heart disease.
Key Words: Superior vena cava, coronary sinus, arrhythmias
Correspondence: David Morgan, Specialist Registrar, Department of Therapeutics and Pharmacology, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, U.K. Tel.: +44(0)2990272254; Fax: +44(0)2890438346; E-mail: d.morgan{at}qub.ac.uk
[1] Doig JC, Saito J, Harris L, et al. Coronary sinus morphology in patients with atrioventricular junctional reentry tachycardia and other supraventricular tachyarrhythmias. Circulation 1995; 92: 436–441.
[2] Momma K and Linde LM. Abnormal rhythms associated with persistent left superior vena cava. Pediatric Res 1969; 3: 210–216.[ISI][Medline]
[3] Steinberg I, Dubilier W, Lucas D. Persistence of left superior vena cava. Dis Chest 1953; 24: 479–488.[ISI][Medline]
[4] Fraser RS, Dvorkin J, Rossall RE, et al. Left superior vena cava: a review of associated congenital heart lesions, catheterization data, and roentgenologic findings. Am J Med 1961; 31: 711–716.[CrossRef][ISI][Medline]
[5] Winters FS. Persistent left superior vena cava: survey of world literature and report of thirty additional cases. Angiology 1954; 5: 90–132.
[6] Campbell M and Deuchar DC. The left-sided superior vena cava. Br Heart J 1954; 16: 423–439.
[7] Bunger PC, Neufeld DA, Moore JC, et al. Persistent left superior vena cava and associated structural and functional considerations. Angiology 1981; 32: 601–608.
[8] Lembo CM and Latte S. Persistence of the left superior vena cava: A case report. Angiology 1984; 35: 58–62.
[9] Mazzucco A, Bortolotti U, Stellin G, et al. Anomalies of the systemic venous return: a review. J Card Surg 1990; 5: 122–133.[Medline]
[10] Bourdillon PD, Foale RA, Somerville J. Persistent left superior vena cava with coronary sinus and left atrial connections. Europ J Cardiol 1980; 11: 227–234.
[11] Westerman GR, Baker J, Dungan WT, et al. Permanent pacing through a persistent left superior vena cava: an approach and report of dual-chambered lead placement. Ann Thorac Surg 1985; 39: 174–176.[Abstract]
[12] Anderson RH and Latham RA. The cellular architecture of the human atrioventricular node, with a note on its morphologyin the presence of a left superior vena cava. J Anat 1971; 109: 443–455.[ISI][Medline]
[13] Chiang CE, Chen SA, Yang CR, et al. Major coronary sinus abnormalities: identification of occurrence and significance in radiofrequency ablation of supraventricular tachycardia. Am Heart J 1994; 127: 1279–1289.[CrossRef][Medline]
[14] Pansky B. Review of Medical Embryology. 1982; New York Macmillan 308–317.
[15] Anderson RH, Ho SY, Smith A, et al. Study of the cardiac conduction tissues in the paediatric age group. Diagn Histopath 1981; 4: 3–15.
[16] Anderson RH, Becker AE, Wenink ACG. The development of the cardiac specialized tissue. In Wellens HJJ, Lie KE, Janse MJ (Eds.). The Conduction System of the Heart: Structure, Function, and Clinical Implications 1976; Philadelphia Lea & Febiger pp. 3–28.
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