ASD device closure: “ Mind the gap ” to avoid SA nodal artery compression.

The branching pattern of the human cardio-vascular tree is as unique as one’s fingerprint. One such hugely variable anatomy is the SA nodal blood supply. Certain salient features Variation can be seen in origin, course, and termination. Now it is estimated to arise from RCA in 70% (Moved up from 55% in old studies ) From LCX (25%) Dual SA node supply(5%) Direct from Aorta It is heartening to find this good anatomical review on this topic. A) From the Right Coronary Artery; (B) From the Left Circumflex Artery (proximal); (C) From the Left Circumflex Artery (distal); (D) From the Left Coronary Artery; (E) From the Aorta; (F) Dual origin from the Right Coronary Artery and the Left Circumflex Artery. Image source : Vikse J, PLoS ONE 11(2): e0148331 Implication for the surgeon The whereabouts of this tiny, yet important artery is critical to the surgeons’ as they incise and explore the atrial roof. (A gateway, that gives access to so many cardiac surgeries) The SA nodal artery mostly goes retro caval but it can be peri-caval or even anterior to SVC. This image shows (a,b,c) the course in relation to SVC, Developmentally as the venous pole go posteriorly to fix the SA artery behind it.Image source : Vikse J, PLoS ONE 11(2): e0148331 For the Interventional cardiologist A rare but distinct mechanical compression of SA node artery is reported with large ASD closure device. The plane of compression is usually occurring in the superior aspect of IAS when the SA node ar...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Cardiology research topics cardiology research topics for fellows Uncategorized ASD device closure cardaic lymphatics cardiology reserach topic sa nodal compression during asd device closure Source Type: blogs