Sex differences in diameter of the coronary sinus ostium: Correlation with weight of the heart

Diameter of the coronary sinus ostium is important in the designing of cannulation devices used in cardiac resynchronization therapy and percutaneous mitral valve annuloplasty. Population variation of the diameter may account for the failure rate of these procedures. Studies of the coronary sinus ostium from African populations are scarce and altogether absent for Kenya. Therefore, this study aimed at determining sex differences in the diameter of coronary sinus ostium and its correlation with the weight of the heart. Seventy-four hearts of adult black Kenyans [43 male, 31 females; age range 20 – 70 years] obtained during autopsy at the Department of Human Anatomy, University of Nairobi, Kenya were weighed. The coronary sinus ostium was identified and its transverse and supero-inferior diameters measured in millimeters. The measurements were analyzed using SPSS version 17. Sex comparison was established using student’s t test. Association between diameter and heart weight was established using Pearson’s correlation test and considered significant at a p-value of ≤0.05. Data were presented using scatter plots. Transverse and supero-inferior diameters of the ostium were 11.04±1.88mm and 9.50±1.80mm respectively. The mean diameter was 10.27 mm. These correlated positively with weight of the heart. When corrected for weight of the hearts, the transverse and supero-inferior diameters were larger in females (0.042 and 0.036 respectively) than in males (0.034 and 0.03 respectively). The diameter of coronary sinus ostium is larger in females and shows positive correlation with weight of the heart. These data should be considered during design and use of cardiac devices introduced through the coronary sinus.Key words: Coronary sinus, ostium, diameter, sex difference.

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ATRESIA OF THE CORONARY SINUS OSTIUM WITH ANOMALOUS DRAINAGE INTO INNOMINATE VEIN: CARDIAC RESYNCHRONIZATION THERAPY AND IMPLICATIONS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)32920-1 ◽

2019 ◽

Vol 73 (9) ◽

pp. 2314

Author(s):

Syed Rafay Ali Sabzwari ◽

Lohit Garg ◽

Fnu Vikram ◽

Nikhil Mehta ◽

Hiwot Ayele ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Coronary Sinus ◽

Innominate Vein ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Coronary Sinus Ostium ◽

Sinus Ostium

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Introducer Development for Coronary Sinus Access from Parasternal Mediastinotomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000164 ◽

2015 ◽

Vol 10 (3) ◽

pp. 202-208

Author(s):

Henry M. Spotnitz ◽

Keith J. Yeager ◽

Santos E. Cabreriza ◽

Gordana Vunjak-Novakovic ◽

Daniel Y. Wang ◽

...

Keyword(s):

Coronary Sinus ◽

Biventricular Pacing ◽

Twist Angle ◽

Human Anatomy ◽

Cardiac Resynchronization ◽

Bend Angle ◽

Coronary Sinus Ostium ◽

Fresh Frozen ◽

Coronary Sinus Lead ◽

Materials Used

Objective Right parasternal mediastinotomy with right atriotomy has been used clinically for pacemaker insertion. A similar approach might facilitate access to the coronary sinus for biventricular pacing and other manipulations when more conventional approaches are not feasible. The primary barrier to this is lack of appropriate introducers and techniques. Methods Anatomically derived introducers were developed in 2 anesthetized domestic pigs using data from computerized axial thoracic tomography. Each digitized tomogram defined a unique introducer shape and was constructed using 3-dimensional (3D) modeling software and printing. Each parent pig then underwent surgery demonstrating coronary sinus lead insertion, using its custom-configured introducer. Next, with institutional review board approval, 65 patients were identified who had undergone conventional endocardial coronary sinus lead insertion followed by thoracic scanning. These tomograms were used to design appropriately curved introducers for human anatomy. Results Fifty-one introducer paths were defined following anatomic pathways and avoiding bends inconsistent with materials used for commercial peel-away introducers. Each path was defined by a bend and distance toward the coronary sinus ostium and a hook and twist out of plane to align with the local orientation of the coronary sinus. The average dimensions were the following: distance, 67 mm; bend angle, 47 degrees; hook angle, 39 degrees; and twist angle, 20 degrees. A prototype cannula was tested for fit in a fresh frozen postmortem human specimen. Conclusions Parasternal mediastinotomy access to the coronary sinus for cardiac resynchronization, mitral annuloplasty, and instrumentation is feasible. Human computerized tomographic scans can be used to define curvatures and dimensions for marketed introducers.

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