有关冠状窦心导管术的应用解剖

对３０例成人心标本进行解剖，测得冠状窦口的纵径为１７．７９±４．６６ｍｍ，横径为８．７５±３．３９ｍｍ。发现冠状窦口朝向上或水平方向者占７０．００％；向下者占３０．００％，冠状窦瓣有新月状、半月状、网状、筛状和嵴状等五种形态。瓣高５．３１±４．１８ｍｍ，宽８．６２±２．４４ｍｍ。冠状窦的长度为３１．３３±１０．２２ｍｍ，最窄径为５．６０±１．０５ｍｍ；并有成角、缩窄和发育不良现象。其属支中有７３．３３％的心中静脉和１０．００％的心小静脉开口于冠状窦口处。本文并就冠状窦心导管术插管的成败因素进行了讨论。     

国人心脏浅表静脉观察

<正> 作者利用铸形及解剖剥离方法观察80例国人心脏浅表静脉。成人冠状窦平均长3.41cm,口径0.84cm,冠状窦口有瓣膜者占72.73％。冠状窦表面有来自心房的肌束覆盖。8例心大静脉瓣为成对的半月形。心大静脉前降动脉左旋动脉三角出现率为70.73％。心小     

左头臂静脉与冠状窦异常交通1例

作者在对一成年男尸解剖时，发现其左头臂静脉与冠状窦之间存在交通静脉（附图）。报告如下：该交通静脉起自左头臂静脉始端下壁，经主动脉弓左前方，左肺动脉始端之前，穿心包注入冠状窦。长９ｃｍ，外径５ｍｍ，行程较直，内有凝血。头臂静脉与冠状窦之间存在交通静脉极为罕见。因异常交通静脉的存在，增大了冠状窦的静脉压，减小了冠状窦与其细小属支之间的压力差，冠脉回流速度减慢。可导致心脏静脉系统淤血，冠状动脉血流阻力增大，血流量减少。影响心脏的泵血功能，特别是在剧烈运动时可能会产生严重后果。在心脏外科手术时，阻断血流…     

头臂静脉与冠状窦之间异常交通支1例

<正>在解剖一具成年尸体(男,约60岁)时,发现头臂静脉与冠状窦异常交通支一例,此种变异十分罕见,详细报告如下(附图1)。该静脉起自左头臂静脉,在距离静脉角约2.4cm,此处管径约0.45 cm;距离左右头静脉汇合处约6.8 cm,此处管径约0.71 cm;经纵膈左侧,跨过主动脉弓前方,左主支气管和肺静脉之间,穿心包,沿冠状沟与心大静脉一同汇入冠状窦。此静脉     

冠状窦及其属支的观察

冠状窦及其属支是心静脉系的主要组成部分,回流整个心脏的60％静脉血,最后经冠状窦口汇入右心房。关于这方面的国人体质资料不多,仅金崇厚、毕建础等及石中梁作过一些调查。为了积累资料,更正确地反映冠状窦及其属支的形态,作者进行了本工作。共解剖经固定的50例或人心脏,绝大多数为男性。先测量冠状窦的长度及管径,观察其属支的数目、起始、走行及注入等。然后纵行切开冠状窦及其主要属支的管壁,检查其瓣膜及开口等。     

心前静脉系统的应用解剖

目的：研究心前静脉系统属支的形态特征，为临床提供解剖学基础。方法：经10％福尔马林固定后的58例成人尸体心脏标本，在肉眼或低倍放大镜下直接解剖、观察心前静脉的各属支。结果：在58例心脏中发现有缘静脉、有心室前静脉、动脉圆锥静脉、动脉圆锥后静脉和主动脉壁静脉通过各种组合形式构成心前静脉系统，最后经壁内静脉窦注入有心房。结论：了解心前静脉系统是除了冠状窦以外心脏静脉血回流的一个正常的重要通道，对临床心血管疾病的诊治有一定帮助。     

建立猪心大静脉阻塞的动物模型

心大静脉作为冠状静脉窦(简称冠状窦)系统的主要属支,在心脏血液循环中起重要的回流作用,也是现代心脏起搏技术常用的导管放置部位,新近研究发现,安装永久起搏器患者,电极所在静脉血栓发生率为30％。为进一步了解静脉管腔阻塞后心脏结构、功能及电生理参数的变化,指导临床工作,我们采用经皮穿刺技术,放置金属弹簧圈于猪心大静脉近中段,建立心大静脉阻塞的动物模型,并通过X线造影在不同时段进行评估。     

兔心冠状动脉的解剖观察

本文用透明和软X线造影等技术对100例兔心的冠状动脉及其分支分布进行了解剖观察。兔心左冠状动脉前降支与旋支的夹角多为35°-65°(67.8％)。前降支短小,与心大静脉伴行。动物实验结扎前降支,以静脉为标志,在左心耳和动脉园锥之间进行较合适。左室支粗大,是旋支的直接延续,分支到左室前、后壁。左室支与心左缘静脉的关系以在左室支下1/3处交叉者多见。动物实验,单独结扎左室支,在其中1/3处进行为宜。兔心有独立的室间隔动脉供应室间隔的大部分。兔心冠状动脉仅4％形成后降支。窦房结动脉起于左冠状动脉者较多(48.3％);房室结动脉大多起于左冠状动脉(73.4％)。兔心冠状动脉分布类型以均衡型居多(77％),右优势型次之(17％),左优势型最少(6％)。     

三房心合并冠状窦口闭锁一例

作者在解剖50例成人离体心脏时,发现三房心(Cor Triatriatum)合并冠状窦口闭锁一例。报导如下:成人心脏(年龄、性别无法查明),外形呈圆锥形,全心高12.2cm,周径27.5cm,心重285 g。左心房内有隔膜附于房间隔(相当上、中1/3相交处)和心房壁之间,隔膜为纤维肌膜,将左心房分成上、下二腔,上腔有左、右肺静脉口和左房主静脉(Levo atrio-Cardinal vein)口,上腔借隔膜右侧份的二个卵圆形缺口通左房下腔,缺口的大小分别为1.8×1.0cm,0.3×0.1cm。右心房内,冠状窦口完全闭锁,未见房间隔有缺损。冠状窦的长度为3.1cm,管径为0.8cm。心中静脉注入冠状窦右端,心小静脉入心中静脉,心中、小静脉均扩大,两者管径皆为0.5cm。冠状窦的左端有左房主静脉(Levoatrio-Cardinal vein)起始,纵剖冠状窦和左房主静脉,可见两者完全相通,距左房主静脉起点1.2cm处,有心大静脉注入,心大静脉的管径为0.3cm。左房主静脉的长度为5.5cm,管径为0.5cm,它在左心耳底部斜行向上,开口于左心房内,左上、下肺静脉口之间,开口呈卵圆形,大小为0.5×0.2cm。如此,则冠状窦血液借左房主静脉     

长白猪与成年人房室交点区的解剖学比较

目的 观测家猪房室交点区解剖学特征,为比较解剖学积累资料.方法 采用30例长白猪心脏在新鲜状态下测量房室交点区相关数据,建立几何模型处理数据.10％甲醛固定48 h后,用过氯乙烯—丙酮填充剂灌注左、右冠状动脉及其分支,心大静脉及其属支.解剖并观测房室交点区结构.结果 左、右后房室沟和后室间沟呈“Y”型相交.后房间沟呈弧...     

The anatomy of the coronary sinus and its tributaries

The coronary sinus and its tributaries were studied by anatomical dissection in 37 adult human cadaveric hearts, which had been fixed in formalin solution. An anastomosis of approximately 1.0mm in calibre was observed between the anterior and posterior interventricular veins in 19% of specimens. Myocardial bridges were detected above the anterior interventricular vein or its tributaries in 8% of specimens. The great cardiac vein formed the base of the arteriovenous trigone of Brocq and Mouchet with the bifurcating branches of the left coronary artery in 89% of specimens and formed an angle accompanying these arterial branches in 11%. In the trigone the anterior interventricular and great cardiac veins were superficial to the arteries in 73% of specimens. The left marginal vein was present in 97% of specimens, emptying into the great cardiac vein in 81% of cases and into the coronary sinus in the remaining 19%. The small cardiac vein was present in 54% of specimens. In the coronary sulcus the great cardiac vein was adjacent to the circumflex branch of the left coronary artery in 76% of specimens and to the right coronary artery in 5% in 19% there was no relationship with either artery. The coronary sinus maintained a relationship with the right coronary artery in 46% of specimens and with the left coronary artery in 32% in 22% it had no relationship with these vessels.     

Left phrenic nerve anatomy relative to the coronary venous system: Implications for phrenic nerve stimulation during cardiac resynchronization therapy

The objective of this study was to quantitatively characterize anatomy of the human phrenic nerve in relation to the coronary venous system, to reduce undesired phrenic nerve stimulation during left‐sided lead implantations. We obtained CT scans while injecting contrast into coronary veins of 15 perfusion‐fixed human heart‐lung blocs. A radiopaque wire was glued to the phrenic nerve under CT, then we created three‐dimensional models of anatomy and measured anatomical parameters. The left phrenic nerve typically coursed over the basal region of the anterior interventricular vein, mid region of left marginal veins, and apical region of inferior and middle cardiac veins. There was large variation associated with the average angle between nerve and veins. Average angle across all coronary sinus tributaries was fairly consistent (101.3°–111.1°). The phrenic nerve coursed closest to the middle cardiac vein and left marginal veins. The phrenic nerve overlapped a left marginal vein in >50% of specimens. Clin. Anat. 28:621–626, 2015. © 2015 Wiley Periodicals, Inc.     

Intersection patterns of human coronary veins and arteries

Intersections between the coronary veins (CV) and arteries (CA) of 103 adult human hearts were mapped on the heart surface. Then the correlations of these intersection patterns to their localization were studied. Eight spots were selected where one of four major CV (anterior cardiac vein, middle cardiac vein, left posterior ventricular vein, and great cardiac vein) intersected with one of CA and their branches (right coronary artery, posterior interventricular branch, left posterior ventricular branch, circumflex branch, diagonal branch, and anterior interventricular branch). The great cardiac vein (GCV) ran beneath the anterior interventricular branch in 56 specimens out of 103, beneath the diagonal branch in 75 specimens out of 103, and beneath the circumflex branch in 36 specimens out of 103, while the other CV mostly ran over CA. The present observations suggest that the CV on the right side may be formed prior to CA, while the CV on the left side may be formed simultaneously with CA.     

Clinical anatomy of cardiac veins,Vv. cardiacae

New methods of cardiological examination and treatment, such as catheterization and arterialization of the coronary sinus, venous reperfusion and cardioplegia have made necessary an exact account of the distribution pattern and the mode of opening of the cardiac veins. 350 hearts were prepared for examination with macroscopical techniques. There are three systems of the major cardiac veins: tributaries of the coronary sinus, anterior cardiac veins, atrial cardiac veins. Their openings lie in a circle-like arrangement between the ostia of both caval veins and just above the tricuspid valve. In most cases there are variably sized intramural collecting chambers or sinuses just before the opening of all the cardiac veins. These sinuses are interpreted to favour the return of cardiac venous bloodstream from the myocardium to the right atrial cavity. The tributaries of the coronary sinus and of the anterior cardiac veins are very variable. There is for instance only in 36% of cases a small cardiac vein, which belongs to the coronary sinus system. In 64% a small cardiac vein does not exist, but its origin, the right marginal vein, joins the system of anterior cardiac veins. This behaviour diminishes the function of the coronary sinus and increases the importance of the system of anterior cardiac veins. Intramural courses of the great cardiac vein, crossing coronary arteries, ostial valves of cardiac veins, ostial valve of coronary sinus and of inferior vena cava, ostial occlusion of coronary sinus, and aneurysm like excavation of the posterodorsal wall of the right atrium have been described also. These facts and structures may cause morphological hindrances fo catheterization of the right atrium and coronary sinus and for reperfusion of cardiac venous drainage pathways. This report about a large conus vein, which is a great cardiac vein joining anterior cardiac veins and about intramural courses of great cardiac vein as well as semicircular venous sinuses in the wall of the right atrium is the first in the literature.     

Endoscopic study of the morphology of Vieussens valve

Vieussens valve (Vv) is the ostial valve of the great cardiac vein located near the beginning of the coronary sinus. Knowledge of its anatomy is important for several trans-sinus cardiologic procedures. The frequency of its presence is reported to vary from 65-87%. We documented the post mortem morphology of Vieussens valve in 50 unfixed, intact human coronary sinuses using endoscopy. We believe this is the first study of the anatomy of the coronary sinus and the adjacent venous ostia to employ this technique. Vieussens valve was observed in 78% of specimens. Special attention was given to the shape of the valve leaflets. Five morphological types of Vv were distinguished: single leaflet, flat (16%); single leaflet, concave (20%); double leaflet, flat (8%); double leaflet, concave (32%); and triple leaflet, concave (2%). We found post mortem endoscopy of the coronary sinus to be a good and reliable method of visualizing Vieussens valve.     

Anomalous venous system in the human heart

In a 2002 cadaveric dissection course, a complex manner of rare variation was found in the abnormal venous system of the heart of an 88-year-old Japanese man who died of acute pneumonia. The superior vena cava and the left and right brachiocephalic veins were normal. In this case, a complex venous system existed as follows. (1) A left superior vena cava was persistent. (2) The innominate vein was present. It went upward between the ascending aorta and the pulmonary trunk, passed through the ventral side of the bifurcation of the pulmonary trunk, and then anastomosed with the left superior vena cava. The oblique vein of the left atrium, as a fibrous bundle, was connected to the junction of the left superior vena cava and the innominate vein in the pericardium. (3) The great cardiac vein was divided into two branches. One was located at the right side of the left coronary artery, forming the origin of the innominate vein. The other extended to the coronary sinus as a normal great cardiac vein. (4) The orifice of the coronary sinus on the right atrium was obliterated. (5) The abnormal orifice existed between the left atrium and the coronary sinus. The formation process and functional significance of such venous variations are discussed.     

Myocardial coverage of the coronary sinus and related veins

The incidence and distribution of landmarks relating to the coronary sinus (c.s.) were evaluated in 240 human hearts. Special attention was directed to the myocardial coat of the c.s., the distribution and pattern of the cardiac veins, and their dimensions. In all specimens the myocardial coat of the c.s. also covered the adjacent 2 to 11 mm of the great cardiac vein. In 15% of cases this myocardial layer was thickened in a sphincter-like fashion, the edge of which was formed obliquely, in a crescent-like manner, or diffusely without a sharp border. In 3% of the hearts the myocardial cover of the c.s. extended over the terminal 10 mm of the middle cardiac vein as a strong fiber cord. In 9%, single isolated belts of fibers fixated the terminal parts of the adjoining cardiac veins to the posterior wall of the left atrium, and in 8% two or three myocardial cords, embedded in the fatty tissue of the left coronary sulcus, did the same. Because the myocardial cover extended leftwards to variable distances over the c.s., the left edge of the myocardial covering cannot serve to define the beginning of the coronary sinus. The location of the ostial valve of the great cardiac vein (valve of Vieussens) was variable as well, being found on the average 2.5 mm proximal to the opening of the oblique vein of the left atrium. Moreover, the valve of the great cardiac vein was found in only 87% of cases; therefore it is inappropriate for defining the beginning of the coronary sinus. Finally, the dot-like ostium of the oblique vein was most constant, and from the viewpoint of embryologic development, it is the logical landmark for determining the beginning of the coronary sinus, a necessary presupposition for cardiologic procedures like reperfusion of cardiac veins.     

A case of anomalous bronchial artery ramified from coronary artery

There have been no anatomical reports on the origin of the bronchial artery derived from the coronary artery. In a 2006 cadaveric dissection course, an anomalous bronchial artery that reached the middle lobe of the right lung from the left coronary artery was observed in an 88-year-old Japanese man. In this specimen, the circumflex branch of the left coronary artery passed under the left auricle in the coronary sulcus and bifurcated to three branches (left marginal branch, posterior left ventricular branch, atrial branch), which were 3.2–3.4 mm in diameter. The atrial branch intersected on the surface of the great cardiac vein, ran along the oblique vein of the left atrium, and reached the atrial side of the transverse pericardial sinus, and then divided into two branches. One of them led to the right atrium. The other branch passed between two right superior pulmonary veins, which derived from superior and middle lobes of the right lung, respectively, through the hilum of the lung along the right superior pulmonary vein derived from the middle lobe, and finally became the bronchial artery in the middle lobe of the right lung. In the middle lobe, the bronchial artery divided into a thin branch along the pulmonary vein for the lateral segment, ran along the surface of the right middle bronchus, and then reached the medial segment, being wedged between the segmental bronchus and vein.     

心大静脉异常引流28例CT特征分析

目的 探讨心大静脉异常引流的CT影像特征。方法 回顾性研究。收集2007年5月-2018年8月复旦大学附属华东医院放射科53 185例行心脏CT检查资料中。纳入心大静脉异常引流的患者28例,其中男12例、女16例,年龄25~79岁。患者均采用德国西门子双源CT 进行扫描,对CT扫描图像进行多平面重建,在CT重建图像上观察心大静脉的走行及异常引流的位置,测量心大静脉的长度,心大静脉异常引流汇入上腔静脉处(汇入点)和左心房入口处(入口处)的直径及CT值,以及冠状静脉窦的直径;观察有无合并心脏畸形。结果 28例患者中,心大静脉引流入上腔静脉19例,引流入心房9例(左心房7例、右心房2例)。心大静脉引流入上腔静脉19例患者,心大静脉的长度为17~26 mm,汇入点距离上腔静脉左心房入口处的距离为1~8 mm,汇入点的直径为2.5~4 mm,入口处的CT值为20~60 HU,冠状静脉窦的直径为2.5~5 mm;其中合并的心脏畸形包括室间隔膜部缺损1例。心大静脉异常引流入心房9例患者,其中引流入左心房前壁者6例、右心房顶部靠近房间隔处2例、左心房左侧壁者1例;心大静脉的长度为15~36 mm,入口处的直径为2.8~4.5 mm,入口处的CT值为400~600 HU,冠状静脉窦的直径为2.5~5 mm;其中合并心脏畸形包括无顶冠状静脉窦2例、卵圆孔未闭1例、冠状动脉瘘1例、右室双出口1例。结论 心脏CT检查是发现心大静脉异常引流的有效方法,多种后处理技术相结合可避免漏诊和误诊的发生。     

The relative anatomy of the coronary arterial and venous systems

An anatomical understanding of human coronary arterial and venous systems is necessary for device development and therapy applications that utilize these vessels. We investigated the unique use of contrast‐CT scans from perfusion‐fixed human hearts for three‐dimensional visualization and analysis of anatomical features of the coronary systems. The coronary arterial and venous systems of eleven perfusion‐fixed human hearts were modeled using contrast‐CT and Mimics software. The coronary arteries that coursed near the major coronary veins, how close coronary arteries were to coronary veins, and the size of adjacent coronary arteries were recorded and analyzed. The majority of coronary veins were within 5 mm of a coronary artery somewhere along its length. Interventricular veins elicited the largest occurrence of overlaps. There was significant variability in the percentage of each vein that coursed within 0.5, 1, 2, and 5 mm of a nearby artery. The left marginal veins and anterior interventricular vein had the largest portion of the vein that coursed near a coronary artery. The right coronary artery most often coursed near the middle cardiac vein. The inferior veins of the left ventricle elicited the most variation in adjacent arteries. The left circumflex artery and/or branches of the circumflex artery coursed near the left marginal vein in all cases where there was an artery near the marginal vein. The wide variation of measurements reinforces the importance of a precise understanding of individualized cardiac anatomy in order to provide the highest quality care to cardiac patients. Clin. Anat. 27:1023–1029, 2014. © 2014 Wiley Periodicals, Inc.