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Ann Thorac Surg 2005;79:388-389
© 2005 The Society of Thoracic Surgeons

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Correspondence

Reply

Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland

denis_berdajs{at}hotmail.com

To the Editor:

The investigations in our article [1] on the clinical anatomy of the sinus node artery (SNA) involved 50 explanted human hearts. The course and the origin of the SNA were classified, and the relation between the course of the artery and the superior septal approach was emphasized. Collected data were compared with clinical results; occurrences of rhythm disturbances after the superior transseptal approach corresponded to our morphological observations more than 50% of the time. Extracardiac origins of the SNA and collaterals to the SNA were not mentioned. However, in 1% of the dry dissected specimens, an anastomosis between the right and left SNAs was detected. It is well known that the bronchial branches supply the sinus node in 2% of studied cases [2].

Adachi [3] compared the anatomy of the coronary vessels in Japanese and Europeans. The difference in heart vascularization between the two populations was marked, but the blood supply of the conducting system was not described.

In our opinion, the anatomy of the SNA could also be different between Japanese and Europeans. This could explain the various results in reports emphasizing sinus rhythm disturbances after the superior transseptal approach [4–6]. However, this theoretical suggestion must be supported by comparative morphological analyses of the SNA.

Misawa and associates [6] supposed that the preferable clinical outcomes after the superior septal approach are due to the development of collateral blood vessels in the sinus node area. In their clinical trial, sinus node arrhythmias were detected postoperatively for 6 months. On the basis of our morphological studies, we do not believe that sufficient collaterals can be generated in this short interval. However, their results may support the theory that the morphology of the sinus node blood supply in various populations is different.

References

1. Berdajs D, Patonay L, Turina MI. The clinical anatomy of the sinus node artery. Ann Thorac Surg. 2003;76:732–736[Abstract/Free Full Text]
2. Hdiselimov H. Vascularization of the conducting system in the human heart. Acta Anat (Basel). 1978;102:105–110[Medline]
3. Adachi B. Das arteriensystem der Japaner; vol 1. Verlag der Kaiserlich, Japanischen Universitat Kyoto, Kyoto; 1928:17–22
4. Alfieri O, Sandrelli L, Pardini A, et al. Optimal exposure of the mitral valve through an extended vertical transseptal approach. Eur J Cardio-thorac Surg. 1991;5:294–299[Abstract]
5. Tambuer L, Meyns B, Flameng W, Daenen W. Rhythm disturbances after mitral valve surgery: comparison between left atrial and extended transseptal approach. Cardiovasc Surg. 1996;4:820–824[Medline]
6. Misawa Y, Fuse K, Kawahito K, Saito T, Konishi H. Conduction disturbances after superior septal approach for mitral valve repair. Ann Thorac Surg. 1999;68:1262–1265[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Berdajs, D. Articles by Turina, M. I. Search for Related Content PubMed Articles by Berdajs, D. Articles by Turina, M. I. Related Collections Cardiac - other Related Article