scholarly journals Variations in Draining Patterns of Right Pulmonary Veins at the Hilum and an Anatomical Classification

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
M. S. Rajeshwari ◽  
Priya Ranganath
Keyword(s):  
Atrial Fibrillation ◽  
Mr Imaging ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Ct Angiography ◽  
Pulmonary Veins ◽  
Inferior Pulmonary Vein ◽  
Superior Pulmonary Vein ◽  
Anatomical Classification ◽  
The Right

Pulmonary veins carry oxygenated blood from the lungs to the left atrium. Variations are quite common in the pattern of drainage. The present study was undertaken to evaluate the incidence of different draining patterns of the right pulmonary veins at the hilum by dissecting the human fixed cadaveric lungs. Clinically, pulmonary veins have been demonstrated to often play an important role in generating atrial fibrillation. Hence, it is important to look into the anatomy of the veins during MR imaging and CT angiography. In 53.8% of cases, the right superior lobar vein and right middle lobar vein were found to be united together to form the right superior pulmonary vein. In contrast to this, in 11.53% of cases, right middle lobar vein united with the right inferior lobar vein to form the right inferior pulmonary vein, while in 26.9% of cases, the right superior lobar vein, right middle lobar vein, and right inferior lobar vein drained separately.

scholarly journals Metastatic renal cell carcinoma extending to the left atrium through the inferior pulmonary vein

2021 ◽  
Author(s):  
Alan G Dawson ◽  
Cathy J Richards ◽  
Leonidas Hadjinikolaou ◽  
Apostolos Nakas
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Pulmonary Veins ◽  
Lower Lobe ◽  
Inferior Pulmonary Vein ◽  
The Right

Abstract Metastatic renal cell carcinoma with involvement through the pulmonary veins to the left atrium is very rare. We report the case of a 70-year-old male with metastatic renal cell carcinoma to the right lower lobe of the lung abutting the inferior pulmonary vein with extension to the left atrium without pre-operative evidence. Surgical resection was achieved through a posterolateral thoracotomy. Lung masses that abut the pulmonary veins should prompt further investigation with a pre-operative transoesophageal echocardiogram to minimize unexpected intraoperative findings.

Clarifying the anatomy of the superior sinus venosus defect

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319334
Author(s):  
Jay Relan ◽  
Saurabh Kumar Gupta ◽  
Rengarajan Rajagopal ◽  
Sivasubramanian Ramakrishnan ◽  
Gurpreet Singh Gulati ◽  
...  
Keyword(s):  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Interatrial Septum ◽  
Sinus Venosus ◽  
Caval Vein ◽  
Therapeutic Implications ◽  
Superior Caval Vein ◽  
Inferior Pulmonary Vein ◽  
The Right

ObjectivesWe sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography.MethodsCT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed.ResultsThe median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients.ConclusionAnomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.

COR TRIATRIATUM WITH INTACT SUBDIVIDING DIAPHRAGM AND PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION TO THE PROXIMAL LEFT ATRIAL CHAMBER (AN UNREPORTED TYPE)

PEDIATRICS ◽  
1971 ◽  
Vol 47 (4) ◽  
pp. 745-750
Author(s):  
James W. Wilson ◽  
Thomas P. Graham ◽  
John A. Gehweiler ◽  
Ramon V. Canent
Keyword(s):  
Left Ventricle ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Cor Triatriatum ◽  
Hypoplastic Left Ventricle ◽  
Inferior Pulmonary Vein ◽  
Superior Pulmonary Vein ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

The clinical, cardiac catheterization, and postmortem findings are presented in a 9-day-old infant with cor triatriatum, anomolous pulmonary venous connections, and a hypoplastic left ventricle. The dorsal accessory left atrial chamber did not communicate with the ventral or proximal left atrium, but did have a small connection with the right atrium. The left superior pulmonary vein connected with the accessory left atrium while the left inferior pulmonary vein connected with the proximal left atrium. The latter pulmonary venous connection has not been described previously in classical cor triatriatum and raises new embryological considerations.

scholarly journals A study on pulmonary venous ostia pattern in the left atrium and its clinical applications

2018 ◽  
Vol 7 (04) ◽  
pp. 201-204
Author(s):  
Rajesh S. ◽  
Vijaya Kumar S. ◽  
Manikanda Reddy V.
Keyword(s):  
Atrial Fibrillation ◽  
Radio Frequency ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Anatomical Variation ◽  
Pulmonary Veins ◽  
Clinical Applications ◽  
Ectopic Beats ◽  
The Right ◽  
Formalin Fixed

Abstract Background & aims : Normally four pulmonary veins open into the left atrium. Frequently there are variations in the number of pulmonary veins opening in to the left atrium. Ectopic beats in atrial fibrillation commonly originates from the ostia of the pulmonary veins. The treatment of atrial fibrillation is by radio frequency ablation of the focus of origin and hence the knowledge of anatomical variation of pulmonary veins is necessary to find the ectopic focus in the origin of atrial fibrillation. Materials and Method : In this study the variation of pulmonary venous ostia pattern in the left atrium was studied in 80 formalin fixed adult cadaveric hearts. Results and Conclusion : 63 hearts showed no variation in the pulmonary venous ostia pattem which accounts for 78.75%, rest of the 17 hearts showed variation in the pulmonary venous ostia which accounts for 21.25%, the variation in the number of pulmonary veins was slightly higher for the left side [11.25%] when compared to the right sided variation [ 10%], the number of hearts which showed bilateral variation was noted in 2 hearts - both showed a single pulmonary vein opening on either side which accounts for 2.5%

scholarly journals Safety and Efficacy Using the Second-Generation Cryoballoon in Patients With Atrial Fibrillation and a Common Ostium of Inferior Pulmonary Veins

2021 ◽  
Vol 8 ◽  
Author(s):  
Hai-yang Xie ◽  
Xiao-gang Guo ◽  
Jian-du Yang ◽  
Jia-hui Li ◽  
Yan-qiao Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Second Generation ◽  
Anatomic Variation ◽  
Pulmonary Veins ◽  
Consecutive Series ◽  
Safety And Efficacy ◽  
Inferior Pulmonary Vein ◽  
The Right

Background: Common ostium of inferior pulmonary veins (COIPV) is a kind of pulmonary vein variation. The safety and efficacy of COIPV isolation using the second-generation cryoballoon (CB) ablation remain unknown.Methods: A total of 10 patients with COIPV from a consecutive series of 1,751 patients with atrial fibrillation (AF) were included. Pulmonary vein isolation (PVI) was performed using the second-generation CB.Results: The prevalence of a COIPV was 0.57% in this study. PVI was achieved in all pulmonary veins (PVs) without the need for a touch-up. A segmental freeze strategy was applied for each inferior PV, respectively. The mean number of freeze cycles of inferior PVs was 1.4 ± 0.5 for the left inferior pulmonary vein (LIPV), and 2.0 ± 0.9 for the right inferior pulmonary vein (RIPV). Pulmonary vein potential (PVP) of RIPV could not be monitored in real-time in three cases. Eight of 10 patients (80%) were free from atrial arrhythmias without the use of antiarrhythmic drugs during a follow-up period of 23.6 ± 12.9 months. No procedure-related complications occurred in any of the 10 patients.Conclusions: Common ostium of inferior pulmonary veins is a rare but challenging PV variant. PVI with this unusual anatomic variation using the second-generation 28-mm CB is effective and safe.

scholarly journals Electrical anatomy of the left atrium during atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Adragao ◽  
D Nascimento Matos ◽  
F Costa ◽  
P Galvao Santos ◽  
G Rodrigues ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Refractory Period ◽  
Cycle Length ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Short Cycle ◽  
Superior Pulmonary Vein

Abstract Introduction Twenty years ago, pulmonary veins (PV) ostia were identified as the left atrium (LA) areas with the shortest refractory period during sinus rhythm. Pulmonary veins isolation (PVI) became standard of care, but clinical results are still suboptimal. Today, a special tool using the Carto® electroanatomical mapping (EAM) allows for AF cycle length mapping (CLM), to identify the areas in the left atria with shortest refractory period, during atrial fibrillation. Using this EAM tool, our study aimed to find the LA areas with the shortest refractory period to better recognize electrical targets for catheter ablation. Methods Retrospective analysis of an unicentric registry of individuals with symptomatic drug-refractory AF who underwent PVI with Carto® EAM. CLM was performed with a high-density mapping Pentaray® catheter before and after PVI and in 4 redo procedures. We assessed areas of short cycle length (SCL) (defined as 120 to 250ms), and their relationships with complex fractionated atrial electrograms (CFAE), and low-voltage zones (from 0.1 to 0.3mV). Results A total of 18 patients (8 men, median age 63 IQR 58–71 years) were included. Most patients presented with persistent AF (n=12, 67%), and 4 patients (22%) had a previous PVI. The mean shortest measured cycle length in AF was 140ms (SD ±27ms). All patients presented areas of SCL located in the PVs or their insertion, 70% in the posterior/roof region adjacent to the left superior pulmonary vein (LSPV) (figure 1) and 60% in the anterior region of the right superior pulmonary vein (RSPV). These two areas remained the fastest even after PVI. The anterior mitral region rarely presented SCL (17%). SCL were related to low-voltage areas in 94% and were adjacent to CFAE. Low-voltage areas and CFAE were more frequent and had a larger LA dispersion than SCL. Conclusion We confirmed in 3D mapping that PVs are the LA zones with shortest refractory period, not only in sinus rhythm but also during AF. The persistence of SCL areas in the border zones of the PVI lines suggest the benefit of a more extensive CLM guided ablation. Larger studies are needed. FUNDunding Acknowledgement Type of funding sources: None. Short cycle length mapping

scholarly journals Electrical anatomy of the left atrium during atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Adragao ◽  
D Nascimento Matos ◽  
F Costa ◽  
P Galvao Santos ◽  
G Rodrigues ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Refractory Period ◽  
Cycle Length ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Density Mapping ◽  
Superior Pulmonary Vein

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Twenty years ago, pulmonary veins (PV) ostia were identified as the left atrium (LA) areas with the shortest refractory period during sinus rhythm. Pulmonary veins isolation (PVI) became standard of care, but clinical results are still suboptimal. Today, a special tool using the Carto® electroanatomical mapping (EAM) allows for AF cycle length mapping (CLM), to identify the areas in the left atria with shortest refractory period, during atrial fibrillation. Using this EAM tool, our study aimed to find the LA areas with the shortest refractory period to better recognize electrical targets for catheter ablation. Methods Retrospective analysis of an unicentric registry of individuals with symptomatic drug-refractory AF who underwent PVI with Carto® EAM. CLM was performed with a high-density mapping Pentaray® catheter before and after PVI and in 4 redo procedures. We assessed areas of short cycle length (SCL) (defined as 120 to 250ms), and their relationships with complex fractionated atrial electrograms (CFAE), and low-voltage zones (from 0.1 to 0.3mV). Results A total of 18 patients (8 men, median age 63 IQR 58-71 years) were included. Most patients presented with persistent AF (n = 12, 67%), and 4 patients (22%) had a previous PVI. The mean shortest measured cycle length in AF was 140ms (SD ±27ms). All patients presented areas of SCL located in the PVs or their insertion, 70% in the posterior/roof region adjacent to the left superior pulmonary vein (LSPV) (figure 1) and 60% in the anterior region of the right superior pulmonary vein (RSPV). These two areas remained the fastest even after PVI. The anterior mitral region rarely presented SCL (17%). SCL were related to low-voltage areas in 94% and were adjacent to CFAE. Low-voltage areas and CFAE were more frequent and had a larger LA dispersion than SCL. Conclusion   We confirmed in 3D mapping that PVs are the LA zones with shortest refractory period, not only in sinus rhythm but also during AF. The persistence of SCL areas in the border zones of the PVI lines suggest the benefit of a more extensive CLM guided ablation. Larger studies are needed. Abstract Figure 1

scholarly journals Anatomical correlation between left atrium pulmonary vein ablation targets of atrial fibrillation and adjacent bronchi and pulmonary arteries by MSCT

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan-Jing Wang ◽  
Huan Sun ◽  
Xiao-Fei Fan ◽  
Meng-Chao Zhang ◽  
Ping Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Arteries ◽  
Contact Points ◽  
Pulmonary Vein Ablation ◽  
Adjacent Structures ◽  
Anatomical Correlation ◽  
The Right

Abstract Background The ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical correlation between left atrium (LA)-pulmonary vein (PV) and adjacent structures. Methods Data were collected from 126 consecutive patients using coronary artery CT angiography. The LA roof was divided into three layers and nine points. The minimal spatial distances from the nine points and four PV orifices to the adjacent bronchi and PAs were measured. The distances from the PV orifices to the nearest contact points of the PVs, bronchi, and PAs were measured. Results The anterior points of the LA roof were farther to the bronchi than the middle or posterior points. The distances from the nine points to the PAs were shorter than those to the bronchi (5.19 ± 3.33 mm vs 8.62 ± 3.07 mm; P < .001). The bilateral superior PV orifices, especially the right superior PV orifices were closer to the PAs than the inferior PV orifices (left superior PV: 7.59 ± 4.14 mm; right superior PV: 4.43 ± 2.51 mm; left inferior PV: 24.74 ± 5.26 mm; right inferior PV: 22.33 ± 4.75 mm) (P < .001). Conclusions The right superior PV orifices were closer to the bronchi and PAs than other PV orifices. The ablation at the mid-posterior LA roof had a higher possibility to damage bronchi. CT is a feasible method to assess the anatomical adjacency in vivo, which might provide guidance for AF ablation.

P1415Wide antral circumferential pulmonary vein isolation ablation using a novel balloon cryoablation catheter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A P Martin ◽  
M Fowler ◽  
N Lever
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
The Novel ◽  
Median Treatment

Abstract Background Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established. Purpose To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC. Methods Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block. Results All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated.  Conclusion Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium. Abstract Figure.

Development of the human pulmonary vein and its incorporation in the morphologically left atrium

2001 ◽  
Vol 11 (6) ◽  
pp. 632-642 ◽  
Author(s):  
Sandra Webb ◽  
Mazyar Kanani ◽  
Robert H. Anderson ◽  
Michael K. Richardson ◽  
Nigel A. Brown
Keyword(s):  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Venous Sinus ◽  
Human Embryos ◽  
Crown Rump Length ◽  
Prepared Material ◽  
Marked Disparity ◽  
Dorsal Mesocardium ◽  
The Right

Objective: Using a newly acquired archive of previously prepared material, we sought to re-examine the origin of the pulmonary vein in the human heart, aiming to determine whether it originates from the systemic venous sinus (“sinus venosus”), or appears as a new structure draining to the left atrium. In addition, we examined the temporal sequence of incorporation of the initially solitary pulmonary vein to the stage at which four venous orifices opened to the left atrium. Methods: We studied 26 normal human embryos, ranging from 3.8 mm to 112 mm crown-rump length, and representing the period from the 12th Carnegie stage to 15 weeks of gestation. Results: The pulmonary vein canalised as a solitary vessel within the mediastinal tissues so as to connect the intraparenchymal pulmonary venous networks to the heart, using the regressing dorsal mesocardium as its portal of cardiac entry. The vein was always distinct from the tributaries of the embryonic systemic venous sinus. The orifice of the solitary vein became committed to the left atrium by growth of the vestibular spine. During development, a marked disparity was seen between the temporal and morphological patterns of incorporation of the left-sided and right-sided veins into the left atrium. The pattern of the primary bifurcation was asymmetrical, a much longer tributary being formed on the left than on the right. Contact between the atrial wall and the venous tributary on the left initially produced a shelf, which became effaced with incorporation of the two left-sided veins into the atrium. Conclusions: The initial process of formation of the human pulmonary vein is very similar to that seen in animal models. The walls of the initially solitary vein in humans become incorporated by a morphologically asymmetric process so that four pulmonary veins eventually drain independently into the left atrium. Failure of incorporation on the left side may provide the substrate for congenital division of the left atrium.

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