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Ann Thorac Surg 2003;76:735-736
© 2003 The Society of Thoracic Surgeons
a Department of Cardiac Surgery, University of Szeged, Pecsi-utca 4Szeged 6701 Hungary
e-mail: kovacs{at}surg.szote.u-szeged.hu
This paper is a precise anatomical description of the origin and course of the sinus node artery (SNA) in humans. In 66% it originates from the right coronary artery (RCA); in 62% from the proximal (types A, B, and C); and in 4% from the distal portion (type D). In 34% the origin is from the left coronary artery (LCA) (type E). This is a very useful classification and can be successfully applied in clinical practice if the features are easily recognized on routine coronary angiograms.
The significance of this classification is discussed with respect to the use of the superior septal approach for mitral valve exposure. Authors suppose that supraventricular arrhythmias observed in 60% in the early postoperative period may be due to transsection of the SNA coursing anticlockwise to the left of the superor vena cava (SVC) in types B, C, and E; whereas in types A and D the SNA is coursing to the right of the SVC and is protected. This assumption needs to be proven. However, for complete exposure, the incision must run along the atrioventricular groove in the right atrium, cut through the right auricle and the interatrial septum, and continue on the roof of the left atrium towards the base of the left auricle. This exposure gives a superb view, but the SNA is transected in 96% of the cases (types A, B, C, and E), remaining intact in only 4% (Type D). The reason why not all cases with transected SNAs develop dysrhythmias postoperatively may be due to the numerous anastomoses between surrounding atrial arteries and the arteriolar network of the sinus node. On the other hand, the SNA does not terminate in the sine node in most cases but usually crosses it to give off nutrient branches and, coursing further, supplies larger areas of the right atrial wall. Thus proximal division of the SNA does not completely cut off blood supply from the distal stump; some flow may be available as a retrograde flow coming from distal anatomoses, which are increasing over time. Further development of these collaterals may be the explanation for the relatively quick recovery of sinus node function during the following weeks; preoperative rhythm is restored in most cases by the end of 4–6 weeks.
Surgeons may wonder whether these various types of sinus node arteries bear any relationship to the incidence of different early postoperative dysrhythmias or to late arrhythmic changes after several years following early recovery. Finally, arrhythmologists may wonder whether some "spontaneously" occurring rhythm disturbance, like sick sinus syndrome, or lone atrial fibrillation is related to any of these types.
This article has been cited by other articles:
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  Y. Misawa, Y. Kaminishi, and Y. Sakano Conduction Disturbance After Shutdown of the Sinus Node Artery Ann. Thorac. Surg., January 1, 2005; 79(1): 388 - 388. [Full Text] [PDF]
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