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Publication Detail
Interatrial communication through the mouth of the coronary sinus
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Knauth A, McCarthy KR, Webb S, Ho SY, Allwork SR, Cook AC, Anderson RH
  • Publisher:
    GREENWICH MEDICAL MEDIA LTD
  • Publication date:
    07/2002
  • Pagination:
    364, 372
  • Journal:
    CARDIOL YOUNG
  • Volume:
    12
  • Issue:
    4
  • Status:
    Published
  • Print ISSN:
    1047-9511
  • Language:
    EN
  • Keywords:
    unroofed coronary sinus, atrial septal defects, left sinus horn, SUPERIOR VENA-CAVA, LEFT ATRIUM, ANATOMY, DEFECT
  • Addresses:
    UCL
    Inst Child Hlth, Cardiac Unit
    London
    WC1N 1EH
    England

    Childrens Hosp
    Boston
    MA
    02115
    USA

    Univ London Imperial Coll Sci Technol & Med
    Sch Med, Natl Heart & Lung Inst
    London
    England

    Univ London St Georges Hosp
    Sch Med
    London
    SW17 0RE
    England
Abstract
Objectives: We describe the structure of, and suggest an etiology for, the interatrial communication which can occur through the mouth of the coronary sinus. Based on the study of human embryos, we propose that the defect is best explained by dissolution of the wall of the coronary sinus adjacent to the left atrium, permitting shunting between the atriums through the right atrial orifice of the sinus. Background: An interatrial communication across the mouth of the coronary sinus defect was first described in 1965 by Raghib and colleagues, its existence being predicated on the basis of incomplete formation of the left "atriovenous fold". Their hypothesis implies that the coronary sinus never develops, and thus the atrial septum itself is incomplete. Methods: We have studied the development of the coronary sinus in a series of human embryos. Based on this work, we present the anatomical findings in 6 specimens with varying degrees of dissolution of the walls of the coronary sinus, and ten specimens with isomerism of the right atrial appendages, in which the sinus has never been formed. Results: The coronary sinus defect is not a hole within the atrial septum, but a communication between the atriums through the mouth of the sinus. There was a range of defects in our series of specimens with usual atrial arrangement, extending from complete absence of the walls which normally separate the coronary sinus from the left atrium, to small fenestrations between this vessel and the left atrial cavity. In the hearts with isomerism of the right atrial appendages, however, we never observed an orifice of the coronary sinus. Thus, a coronary sinus defect cannot exist in this setting. Conclusions: Our findings indicate that the defect requires initial formation of the walls of the coronary sinus, but with subsequent dissolution of the wall adjacent to the left atrium. This produces a communication between the atriums through the mouth of the sinus.
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