Uptake of pre-emergent herbicides by corn: distribution in plants and soil

We experienced an uncommon case of coronary sinus atrial septal defect, which was not associated with a left superior vena cava (LSVC). A 29-year-old woman, who experienced fatigue during moderate exercises, was found to have the atrial septal defect located in the lower part of the septum by echocardiography preoperatively. On operation, the coronary sinus ASD was diagnosed. The ostium of coronary sinus was located in the left atrium. This type is classified as partially unroofed coronary sinus without LSVC. Our case, in the absence of the LSVC, was repaired by simple closure of the coronary sinus ASD, so the coronary veins drained into the left atrium. Postoperative course was uneventful.     

Major coronary sinus abnormalities: identification of occurrence and significance in radiofrequency ablation of supraventricular tachycardia

Coronary sinus catheterization is important in electrophysiologic study of patients with supraventricular tachycardia. It can provide an anatomic guide for localization of slow atrioventricular nodal pathway and accessory pathways in the posteroseptal area and left-sided atrioventricular ring. However, the morphologic features of the coronary sinus and its significance in patients with supraventricular tachycardia have not been determined. Four hundred eight patients with accessory pathway-mediated tachyarrhythmia and atrioventricular nodal reentrant tachycardia underwent coronary arteriography for a coronary sinus venogram before electrophysiologic study and radiofrequency ablation. The venous phase of left coronary arteriography that delineated the morphologic features of the coronary sinus was carefully evaluated and recorded in multiple projections. Major coronary sinus abnormalities were defined, and they were found in 12 patients (2.9%). Six patients had angulation of the coronary sinus, 4 patients had hypoplasia of the coronary sinus, 1 patient had narrowing of the proximal coronary sinus, and 1 patient had a fistula from persistent left superior vena cava to the coronary sinus. Of 175 patients with atrioventricular nodal reentrant tachycardia, only 1 patient had major coronary sinus abnormalities (proximal angulation), whereas of 233 patients with accessory pathway-mediated tachycardia, 11 patients had major coronary sinus abnormalities (0.6% vs 4.7%, p < 0.05). The accessory pathways in patients with major coronary sinus abnormalities were located exclusively in the left free wall and posteroseptal area. Proper coronary sinus catheterization could be accomplished in 396 patients with a normal coronary sinus, whereas it could be accomplished in only 1 of the 12 patients with major coronary sinus abnormalities (396/396 vs 1/12, p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Early coronary sinus reroofing using the left atrial baffle

Surgical correction of unroofed coronary sinus, left superior vena cava, dextrocardia, and situs solitus in a 4-month-old infant consisted of reroofing the coronary sinus by means of a left atrial flap while redirecting the left superior vena cava to the right atrium. Excellent access to the left side of the left atrium was afforded by the associated dextrocardia.     

Successful repair of total anomalous pulmonary venous connection and incomplete endocardial cushion defect associated with left isomerism

Successful repair of a 8-month-old girl with polysplenia was reported. The cardiovascular anomalies were TAPVC (II b), incomplete ECD, interruption of inferior vena cava with hemiazygos continuation, bilateral superior vena cava, and left superior vena cava draining into the coronary sinus. Cardiopulmonary bypass was established with ascending aortic perfusion and caval cannulation. A left superior vena cava was directly cannulated after establishing partial bypass. In this case the left pulmonary vein drained into the right atrium near the orifice of the coronary sinus, so the atrial septal flap was made and sutured between the orifice of the left pulmonary vein and the coronary sinus in order to avoid late pulmonary vein obstruction. Then, atrium was separated by an intraatrial baffle which was sutured to the atrial septal flap. Recently, it becomes possible to surgical repair of polysplenia syndrome according to the advancements of the diagnostic methods, cardiopulmonary bypass, and the technique of the open heart surgery.     

Unroofed coronary sinus syndrome

Unroofed coronary sinus syndrome or coronary sinus septal defect is a rare congenital cardiac anomaly. We performed corrective operations in 9 patients with such condition. Of them, seven patients had the completely unroofed coronary sinus and persistent left superior vena cava (PLSVC) directly draining into the left atrium (LA). One patient had PLSVC and the partially unroofed terminal portion of the coronary sinus (CS), or sinus ostium open into LA. Another patient had total anomalous pulmonary vein connection and the partially unroofed mid-portion of CS without PLSVC. The operative methods of the unroofed coronary sinus included: ligating PLSVC and repairing ostium primum or secundum atrial septal defects in 4 cases; creating an intra-atrial tunnel from PLSVC to the right atrium (RA) and repairing the atrial septal defect in 2 cases; reconstructing the intra-atrial septal with a patch as a baffle to guide PLSVC or sinus ostium respectively towards RA in 2 cases; enlarging the defect on the coronary sinus roof and repairing the atrial septal defect of the coronary sinus type in one case. No patient died in this group. Because unroofed coronary sinus syndrome has atypical clinical manifestation and usually complicates varied congenital anomalies, its preoperative diagnosis is very difficult in some times and may draw the reliable support from echocardiography and catheterization. The operative program and method must depend not only upon its type but also upon PLSVC presence of absence, and communication between PLSVC and RSVC.     

Modified repair of mixed anomalous pulmonary venous connection

A modified repair technique is reported for mixed total or partial anomalous pulmonary venous connection with the right superior pulmonary vein connecting to the superior vena cava, the right inferior pulmonary vein to the right atrium or left atrium, and the left pulmonary veins to the coronary sinus. The superior vena cava is transected above the highest right superior pulmonary vein, its cephalad end is anastomosed to the right atrial appendage, and a pericardial baffle is constructed between the cardiac ostium of the superior vena cava, the ostium of the right inferior pulmonary vein, and the left atrium, including the coronary sinus, which is unroofed. The reported technique may be valuable to avoid pulmonary venous obstruction in complex mixed forms of total or partial anomalous pulmonary venous connection.     

Phase II clinical trial of recombinant alpha 2b interferon and 13 cis retinoic acid in patients with metastatic melanoma

In patients considered for bidirectional Glenn or Fontan procedures, the association of left superior vena cava (LSVC) with ostial atresia of the coronary sinus should be diagnosed preoperatively in order to avoid surgical division or ligation of the LSVC and the negative effect of resulting coronary venous hypertension on myocardial perfusion. This report discusses the angiographic and hemodynamic features of LSVC when it is the only drainage route from a blind coronary sinus. A retrograde flow in the LSVC seen by Doppler ultrasonography should raise the suspicion of this diagnosis.     

Renovascular disease: the fifth frontier

BACKGROUND: Coronary sinus type atrial defect is the result of an incomplete formation of the atriovenous fold. This is a rare anomaly that in a very few cases took advantage of echocardiographic diagnosis before surgery. We report on a case of coronary sinus type atrial septal defect diagnosed by means of transthoracic and transesophageal echocardiography. PATIENT: A 65 year old woman who was admitted to hospital for evaluation of dyspnea and pre-syncope. A diagnosis of secundum type atrial septal defect had been achieved few months before. METHOD DESCRIPTION: Color Doppler transthoracic echocardiography demonstrated evidence of left-to-right shunt through the coronary sinus-left atrium common wall, while transesophageal echocardiography showed a defect in the coronary sinus roof in its terminal portion, proximal to the atrial septum. At that level the shunt flow was demonstrated by the presence of a negative contrast after contrast injection. Both transthoracic and transesophageal contrast echocardiographies demonstrated the persistence of a left superior vena cava draining into the enlarged coronary sinus: the existence of a right-to-left shunt at the coronary sinus level suggested by transthoracic echocardiographic examination was not confirmed by transesophageal echocardiography. CONCLUSIONS: This is one of the few reported cases of coronary sinus type atrial defect diagnosed noninvasively and the diagnostic usefulness of both transthoracic and transesophageal echocardiographic approaches is stressed.     

Technique of transplantation for hypoplastic left heart syndrome with left superior vena cava

The presence of a left superior vena cava in infants with hypoplastic left heart syndrome complicates the technical performance of orthotopic cardiac transplantation. In this report we describe a modification of the recipient cardiectomy to maintain patency of the left superior vena cava, leaving the recipient coronary sinus as a conduit for it into the right atrium and avoiding complex venous reconstructions.     

VDD pacing in persistent left superior vena cava

Although persistent left superior vena cava (PLSVC) is the most common major venous anomaly of the heart, associated absence of the right superior vena cava with normal visceral situs is exceedingly rare. Such a patient presented with complete heart block requiring permanent pacing. This was achieved successful using a single lead VDD system via the PLSVC with atrial sensing in the coronary sinus.     

Serum pooling lowers cholesterol recovery

We report a fetus of 35 weeks gestation in which a continuous flow was detected in the lower portion of the right atrium with a peak velocity of 0.8 m/s. After delivery the echo-doppler study showed a dilated coronary sinus in the long axis parasternal view, and a bilateral superior vena cava in the short axis suprasternal notch view. Comments about the cause of this anomalous continuous flow are discussed.     

Atrial macroreentry involving the myocardium of the coronary sinus: a unique mechanism for atypical flutter

Atrial flutter involving either clockwise or counterclockwise rotation around the tricuspid annulus utilizing the subeustachian isthmus has been well described. However, macroreentrant atrial circuits in atypical atrial flutter in patients who have not undergone previous surgery or without atrial disease are not well defined. We describe a patient without structural heart disease who presented with an atrial macroreentrant rhythm. Entrainment mapping demonstrated a critical isthmus within the coronary sinus. Activation mapping demonstrated double potential throughout the length of the coronary sinus with disparate activation sequences. A circuit involving the myocardium of the coronary sinus, exiting in the lateral left atrium, down the interatrial septum, and reentering into the coronary sinus was identified. Successful ablation of the rhythm was accomplished by a circumferential radiofrequency application within the coronary sinus.     

Coronary-to-pulmonary artery shunts via the bronchial artery: analysis of cineangiographic studies

Coronary-to-pulmonary artery shunts via the bronchial artery (CA-BA-PA shunts) were observed in 16 of 2,922 consecutive patients who underwent selective coronary cineangiography. Underlying diseases included Takayasu arteritis (n = 8), chronic pulmonary inflammatory diseases (n = 4), pulmonary thromboembolism (n = 2), pulmonary artery tumor (n = 1), and tetralogy of Fallot with pulmonary atresia (n = 1). Ventilation-perfusion scans were available in 15 of the 16 patients. Mismatched defects were identified in 11 patients, and matched defects were identified in four. Bronchial-to-pulmonary artery shunts were detected on selective bronchial angiograms and/or thoracic aortograms in 13 patients. Feeding arteries of the CA-BA-PA shunts included left atrial branches (n = 13), right sinus node branches (n = 7), left sinus node branches (n = 2), right conal branch (n = 1), left conal branch (n = 1), and posterolateral branches (n = 2). These coronary branches seemed to serve as collateral vessels from a coronary arterial system with a higher pressure to a pulmonary arterial system with a lower pressure in conditions of decreased pulmonary flow or in cases of chronic pulmonary inflammatory disease. The importance of the coronary artery along with other superior thoracic collateral networks in contributing to the development of shunts to the pulmonary artery is underscored.     

Single coronary artery arising from the right coronary sinus. Report of two cases

The authors report two cases of single coronary artery arising from the right coronary sinus. Both patients had angina with reversible myocardial ischaemia on exercise Thallium scintigraphy. Coronary angiography showed single coronary artery arising from the right coronary sinus in both cases with severe stenosis of the right coronary artery in the first and occlusion of the right coronary artery in the second patient. Both underwent surgical revascularisation with a good result. Single coronary artery is a rare congenital abnormality (approximately 0.36 per 1,000) diagnosed at autopsy until 1963, and thereafter at coronary angiography. A review of the literature shows that an equal number of single coronary arteries arise from the right as from the left coronary sinus: there does not seem to be an increased risk of complication when a branch runs between the aorta and pulmonary artery. On the other hand, single coronary arteries arising from the right coronary sinus seem to be more commonly associated with atherosclerosis than a network with two coronary arteries, but when the lesions are proximal, the risk is high. Revascularisation is indicated only when myocardial ischaemia has been documented.     

The protective effect of captopril on the ischemic myocardium in dogs through coronary sinus retroperfusion

The protective effect of coronary sinus retroperfusion of Captopril on the ischemic myocardium was observed in dogs with acute myocardial infarction (AMI). The results showed that the infarction size and the level of coronary sinus plasma endothelin (ET) and manodialdenyde (MDA) were smaller and lower when Captopril was administered by coronary sinus retroperfusion than that by systemic intravenous injection. These results suggest that (1) Captopril can be distributed adequately in the local ischemic myocardial zones when administered by coronary sinus retroperfusion in the presence of coronary artery occlusion, (2) Captopril can more effectively protect ischemic myocardium by inhibition of the ET release and against the oxygen free radicals in ischemic myocardial area when used by coronary sinus retroperfusion.     

Transposition of the great arteries and isolated origin of the sinus node artery

We report the cases of 2 newborns who underwent at 7 days of age an arterial switch operation for transposition of the great arteries with a rare coronary anomaly: the left and right coronary arteries originated with a single ostium from sinus 1 and the sinus node artery had an isolated origin from sinus 2. The sinus node artery was reimplanted into the new aorta in both patients. Both babies were discharged in sinus rhythm. Preserving the vascularization of the sinus node may avoid the occurrence of postoperative atrial rhythm disturbances.     

Retrograde perfusion as a method for myocardial revascularization

Retroperfusion of the superficial coronary venous system was studied in 44 canine fibrillating in vivo, normothermic preparations, with exclusion of the systemic circulation using cardiopulmonary bypass techniques in order to assess its value as a method of myocardial revascularization. Perfusion of either the isolated aortic arch via a brachiocephalic cannula or of the coronary sinus through the free end of a vein anastomosed to the atrial rim of the sinus was performed for 1 h at 100 cm3/min in groups II-IV following 30 min of anoxia. Oxygen uptake, vascular resistance, venous outflow and venous enzyme levels (CPK, GDH) were studied. Group I controls (antegrade perfusion, no anoxia) showed continued aerobic metabolism in contrast to group II (antegrade perfusion) and III (retrograde perfusion) which displayed negative lactate balance. Oxygen consumption was greater in group III than II (p less than 0.01) with a higher oxygen extraction in III (p less than 0.005). Group IV, which was given intravenously 30 mg/kg methylprednisolone prior to anoxia and then retroperfused, showed continued aerobic metabolism with low GDH venous levels and adequate oxygen consumption. Three dogs were then subjected to aortoatrial rim coronary sinus vein grafts with ligation of the left common coronary artery at its bifurcation with distal left circumflex and anterior descending artery-internal mammary vein anastomoses for venous drainage. The right coronary artery was left intact. Arterial inflow into the coronary sinus was associated with a left ventricular pressure of 70-80 mm Hg for up to 1.5 h while regular sinus rhythm was maintained. We conclude that retroperfusion of the coronary sinus represents a surgically feasible technique for providing oxygen delivery to the ischemic myocardium.     

pH sensitive properties of Tc(V)-DMS: analytical and in vitro cellular studies

Coronary arteries anomalies may be part of complex congenital malformations of the heart or be an isolated defect. In our anatomic collection of congenital heart disease, an isolated anomalous origin of coronary arteries was observed in 27 of 1,200 specimens (2.2%): left coronary artery from pulmonary trunk in five, origin from the wrong aortic sinus in 12 (both right and left coronary artery from the right sinus in four and from the left sinus in seven, left coronary artery from the posterior sinus in one), left circumflex branch from right aortic sinus or from very proximal right coronary artery in three, high takeoff of right coronary artery in three, stenosis of the coronary ostia attributable to valvelike ridge in four. In 16 (59%) patients (12 males and 4 females, age ranging from 2 months to 53 years; median, 14), the final outcome was sudden death; it occurred in all cases of left coronary artery origin from right aortic sinus, in 43% of right coronary artery origin from left aortic sinus, and in 40% of the left coronary artery from the pulmonary trunk. Sudden death was precipitated by effort in eight (50%) and was the first manifestation of the disease in eight (50%); previous symptoms consisted of recurrent syncope in four, palpitations in three, and chest pain in one. Five patients who died suddenly during effort were athletes. In conclusion, (1) more than half of our postmortem cases with anomalous origin of coronary arteries died suddenly, (2) all but two patients with sudden death had anomalous coronary artery origin from the aorta itself, (3) the fatal event was frequently precipitated by effort, (4) palpitations, syncope, and ventricular arrhythmias were the only prodromic symptoms and signs. Recognition during life of these coronary anomalies, by the use of noninvasive procedures, is mandatory to prevent the risk of sudden death and to plan surgical correction if clinically indicated.     

Long-term nonprogression in HIV infection. Clinical Epidemiology Group from the Centre d''Information et de Soins de l''Immunodéficience Humaine

Distributions of the cardiac plexuses and cardiac ganglia were gross-anatomically and histologically studied in eight Beijing ducks. The cardiac plexuses consisted of two components, the cardiac nerve arising from the sympathetic trunk and the cranial and caudal cardiac nerves arising from the vagus. Branches of these nerves made the cardiac plexuses on the epicardium. The cardiac plexuses could be divided into the six plexuses, that is, the right and left coronary plexuses, pericardiac transverse sinus plexus, caudal cardiac plexus, and right and left superior cardiac plexuses. There were small ganglia in the caudal cardiac plexus and the right and left coronary plexuses. These ganglia containing multipolar neurons were found like a linking chain in a single nerve.     

Venous microembolic signals detected in patients with cerebral sinus thrombosis

BACKGROUND AND PURPOSE: We sought to assess the usefulness of the Doppler technique in the monitoring of microembolic signals in the main venous outflow pathways in superior sagittal sinus thrombosis. METHODS: Transcranial Doppler ultrasound was performed with a range-gated 2-MHz transducer in 6 patients with superior sagittal sinus thrombosis, in 5 subjects with platelet hyperaggregability, and in 20 healthy volunteers. Emboli monitoring was performed mainly in one distal internal jugular vein for 10 to 15 minutes. RESULTS: Three of the six patients (50%) with superior sagittal sinus thrombosis had microemboli. None of the patients with platelet hyperaggregation or healthy volunteers revealed microemboli. CONCLUSIONS: Microemboli can be found in superior sagittal sinus thrombosis by Doppler ultrasound. Their prognostic significance remains to be determined.