Mutual arrangements of coronary blood vessels within the right atrial
appendage vestibule.
Abstract
Introduction: The aim of our study was to investigate the presence and
mutual relationships of coronary vessels within the right atrial
appendage RAA vestibule. Methods and Results: We examined 200 autopsied
hearts. The RAA vestibule was cross sectioned along its isthmuses
(superior, middle, and inferior). We assessed the presence and mutual
relationships between coronary blood vessels. The right coronary artery
(RCA) was present in 100% of the superior RAA isthmuses but absent in
2.0% of hearts within the middle isthmus and in 6.5% of hearts within
the inferior RAA isthmus. Its diameter was quite uniform along the
superior (2.6±0.8mm), middle (2.9±1.1mm) and inferior (2.7±0.9mm)
isthmuses (p=0.12). The location of the RCA varied significantly, and it
was sometimes accompanied by other accessory coronary vessels. In all
the isthmuses, the RCA ran significantly closer to the endocardial
surface than to the epicardial surface (p<0.001). At the
superior RAA isthmus, the artery was furthest from the right atrial
endocardial surface and this distance gradually decreased between the
middle RAA isthmus and the inferior RAA isthmus (9.0±4.0 vs. 6.2±3.0 vs.
4.8±2.3mm, respectively; p<0.001). The interposed RCA was
found in 7.0% of cases within the superior isthmus, in 2.5% within the
middle isthmus and in 1.5% within the inferior isthmus. Conclusions:
This study was the most complex analysis of the mutual arrangements and
morphometric characteristics of coronary blood vessels within the RAA
vestibule. Awareness of additional blood vessels within the vestibule
can help clinicians plan and perform safe and efficacious procedures in
this region.