Embryological factors in the development of arrhythmia originating in the sinus-atrial node region

    Authors

    Keywords

    venous anomalies, sinus inappropriate tachycardia

    DOI

    https://doi.org/10.15836/ccar2018.333

    Full Text

    Introduction: Inferior vena cava (IVC) congenital anomalies are relatively rare vascular anomalies that are detected accidentally by imaging during the diagnostic treatment of deep vein thrombosis or more frequently, by treating non-vascular pathology. ( 1 - 3 ) Case report: A twenty-seven-year-old patient was hospitalized at the Department of Cardiology of University Hospital “Merkur” for electrophysiological treatment (EPI) due the diagnosis of inappropriate sinus tachycardia (IST) after previously excluded reversible factors of sinus tachycardia and postural orthostatic hypotension. Electrophysiologic study was initiated, but due to unexpected anomalies of the venous system, the same was not done in that act. A MSCT described the duplication of IVC with the continuation of the hemi-azygos veins of the left IVC and the successive right-sided May-Thurner syndrome for which an anticoagulant therapy was initiated, and a thrombophilia test was performed. The patient is homozygous for polymorphism C667T and polymorphism A1298C. In the second act, EPI was performed, confirming the IST and in the same act the sinus node therapeutic modification was done. Conclusion: Left-sided IVC cases associated with congenital heart defects are not often described, and IST has never been described as a possible consequence of venous system malformation. The sinus node is a spinal sub-epicardial specialized muscular structure located postero-laterally within the epicardial groove of the right atrial terminal sulcus, at the junction of the trabecular frontal attachment and the smooth-walled muscular venous component posterior. On the epicardial side, it is placed on the attachment of the superior vena cava with a right atrium and continues down and down the sulcus terminalis and ends subendocardially near the IVC. Localization and embryological development are in favour of the same etiologic factor that has led to an anomaly of IVC and sinus node dysfunction.

    Cardiologia Croatica
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    Embryological factors in the development of arrhythmia originating in the sinus-atrial node region

    Extended Abstract
    Issue11-12
    Published
    Pages333
    PDF via DOIhttps://doi.org/10.15836/ccar2018.333
    venous anomalies
    sinus inappropriate tachycardia

    Authors

    Ena Kurtić*ORCIDUniversity Hospital “Merkur”, Zagreb, Croatia
    Matija MarkovićORCIDUniversity Hospital “Merkur”, Zagreb, Croatia
    Karlo NovačićORCIDUniversity Hospital “Merkur”, Zagreb, Croatia
    Gabrijela Perić MarkovićORCIDUniversity Hospital “Merkur”, Zagreb, Croatia
    Tomislav MeštrovićORCIDUniversity Hospital “Merkur”, Zagreb, Croatia
    Ivica Premužić MeštrovićORCIDUniversity Hospital “Merkur”, Zagreb, Croatia

    Full Text

    Introduction: Inferior vena cava (IVC) congenital anomalies are relatively rare vascular anomalies that are detected accidentally by imaging during the diagnostic treatment of deep vein thrombosis or more frequently, by treating non-vascular pathology. ( 1 - 3 ) Case report: A twenty-seven-year-old patient was hospitalized at the Department of Cardiology of University Hospital “Merkur” for electrophysiological treatment (EPI) due the diagnosis of inappropriate sinus tachycardia (IST) after previously excluded reversible factors of sinus tachycardia and postural orthostatic hypotension. Electrophysiologic study was initiated, but due to unexpected anomalies of the venous system, the same was not done in that act. A MSCT described the duplication of IVC with the continuation of the hemi-azygos veins of the left IVC and the successive right-sided May-Thurner syndrome for which an anticoagulant therapy was initiated, and a thrombophilia test was performed. The patient is homozygous for polymorphism C667T and polymorphism A1298C. In the second act, EPI was performed, confirming the IST and in the same act the sinus node therapeutic modification was done. Conclusion: Left-sided IVC cases associated with congenital heart defects are not often described, and IST has never been described as a possible consequence of venous system malformation. The sinus node is a spinal sub-epicardial specialized muscular structure located postero-laterally within the epicardial groove of the right atrial terminal sulcus, at the junction of the trabecular frontal attachment and the smooth-walled muscular venous component posterior. On the epicardial side, it is placed on the attachment of the superior vena cava with a right atrium and continues down and down the sulcus terminalis and ends subendocardially near the IVC. Localization and embryological development are in favour of the same etiologic factor that has led to an anomaly of IVC and sinus node dysfunction.