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1

The middle cardiac vein as a key for 'posteroseptal' space - a morphological point of view

100%
Kozlowski D., Kozluk E., Piatkowska A., Maruszak H., Gawrysiak M., Grzybiak M., Walczak F.
Folia Morphologica
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2001
|
tom 60
|
nr 4
293-296
About 25% of accessory pathways (AP) run via “posteroseptal” space (PSS). There are three approaches for ablation of these pathways: from the right atrium, from the left atrium or from the ventricle and coronary sinus (CS). However in some cases AP is too far from all of them. Catheterisation of the middle cardiac vein (MCV) seems to be the only chance for successful ablation. Our aim was to evaluate the topography of the MCV in PSS. Classical anatomical investigation was carried out on the autopsy material of 98 consecutive human hearts (42 F, 56 M; age 57 ± 21 yrs). It was supported by transverse section performed under coronary sinus. Regions just behind the atrioventricular septum and behind the cavities were respectively classified as “septal”, right (RP) and left posterior (LP). Between them right (RPS) and left posteroseptal areas (LPS) were present. At the posterior view of the heart the angle between CS and MCV ranged from 75 to 90° in 62% of hearts, 60–75° in 18%, 30–60° in 10% and 90–130° in 10%. In 16% MCV ran via the “septal” region, 59% — LPS, 10% — RPS, 10% — RP and 5% — LP. At the ostium of 58% MCV a valve was observed, however there was no trouble with insertion of the 6F catheter into it. We concluded that it is possible to insert the 6F catheter into MCV, which makes it possible to perform ablation of epicardial postero-inferior accessory pathways. The origin of MCV is usually located in the left “posteroseptal” region and runs towards the left side of the posterior wall.
2

Anterior region of the atrioventricular perinodal area in relation to radiofrequency ablation procedures

84%
Kozlowski D., Maruszak H., Wozniak P., Krupa W., Owerczuk A., Derejko P., Gawrysiak M., Piwko G., Grzybiak M.
Folia Morphologica
|
2001
|
tom 60
|
nr 4
303-307
Atrioventricular nodal reentry tachycardia base on reentry circulation in nodal- -perinodal area. The radical treatment of choice is radiofrequency ablation. Procedure approached from the anterior-superior (fast) region sufficient a few seconds of energy delivery for success, however this can result in A-V block. The possibility that arrhythmias substrate may lie very superficially (success of ablation) and damage the normal structures (complication) in the perinodal region must be considered. In order to confirm this hypothesis we examined the autopsy material of 100 normal hearts, both sexes from 18 to 105 years of age (control) and 50 hearts with A-V total block 45–95 years of age (block). We paid attention to the morphology of the nodal artery (NA), atrial inputs (AI) and transitional inputs (TI). It was observed that NA at the level of the central fibrous body was positioned in 94% in the central and in 6% in the inferior part of Koch’s triangle. It was removed from the endocardium 3–6 mm in control and 2–5 mm in block group respectively (NS). In the perinodal area we distinguished AI that directly joined the A-V compact node: superficial (right part of the interatrial septum) or deep (left part). The former occurred in 100% of controls and in 80% of block groups (NS), and the latter in 80% of control group and in 34% in block respectively (p < 0.05). The real substrate of arrhythmia in anterior-superior region lies very superficially and far from the conduction tissue; NA in examined hearts was lying deep beneath the endocardium; ablation close to the node could result in A-V block.
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