1st Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848 Poznan, Poland.
Department of General, Endocrine and Gastrointestinal Oncology Surgery, Poznan University of Medical Sciences, Przybyszewski Street 49, 60-355 Poznan, Poland.
Europace. 2021 Nov 8;23(11):1787-1794. doi: 10.1093/europace/euab108.
The number of cardiovascular procedures using the coronary sinus (CS) as a gateway is constantly increasing. The present study aimed to define specific structures within CS, which could potentially complicate CS cannulation and to develop a new Thebesian valve (TV) classification system.
The study was performed on 560 consecutive unfixed cadaveric hearts during routine autopsy examination (1-3 days post-mortem). Basic CS dimensions were measured and the presence and dimensions of the TV and the Vieussens valve (VV) were assessed. Thebesian valves were classified according to their morphology into six main types: remnant fold, semilunar, fenestrated, chord, fused strands, and mixed shaped. The median age of hearts was 48 years (range 16-95 years), and 38.9% were female. Thebesian valve was present in 79.5%. The most common TV type was semilunar (54%) followed by fenestrated (8.2%), remnant fold (5.5%), fused strands (4.8%), chord (4.0%), and mixed shaped (3.0%). In 1.1% of hearts, TV totally covered the coronary sinus ostium (CSO). The VV was detected in 67.9%. Potentially occlusive VV was found in 1.1% hearts and in all of which it coexisted with obstructive TV. The median CSO area was 87.9 mm2 [interquartile range (IQR): 56.5-127.1 mm2] and median CS length was 38 mm (IQR: 29.5-45 mm). The CSO area and CS length correlated with each other and with the right atrium's dimensions.
We identified six types of TVs, among which only 1.1% TVs caused total occlusion of CSO. The obstructive TV co-existed with potentially occlusive VV what might hinder CS cannulation.
经冠状窦（CS）作为入路的心血管介入操作数量不断增加。本研究旨在确定 CS 内可能使 CS 插管复杂化的特定结构，并开发新的 Thebesian 瓣（TV）分类系统。
在常规尸检检查期间（死后 1-3 天），对 560 例连续的未经固定的尸体心脏进行了研究。测量了 CS 的基本尺寸，并评估了 TV 和 Vieussens 瓣（VV）的存在和尺寸。根据形态将 TV 分为六种主要类型：残余褶皱、半月形、有孔、索状、融合束和混合形状。心脏的中位年龄为 48 岁（范围 16-95 岁），其中 38.9%为女性。存在 TV 的心脏占 79.5%。最常见的 TV 类型为半月形（54%），其次是有孔（8.2%）、残余褶皱（5.5%）、融合束（4.8%）、索状（4.0%）和混合形状（3.0%）。在 1.1%的心脏中，TV 完全覆盖冠状窦口（CSO）。检测到 67.9%的 VV。在 1.1%的心脏中发现了潜在阻塞性的 VV，并且在所有这些心脏中，它都与阻塞性的 TV 共存。CSO 区域的中位数为 87.9mm²[四分位距（IQR）：56.5-127.1mm²]，CS 长度的中位数为 38mm（IQR：29.5-45mm）。CSO 区域和 CS 长度相互关联，并与右心房的尺寸相关。
我们确定了六种 TV 类型，其中只有 1.1%的 TV 导致 CSO 完全阻塞。阻塞性 TV 与潜在阻塞性的 VV 共存，可能会阻碍 CS 插管。
