Hamilton K, Castillo M, Arruda M, Jackman W
Department of Medicine, University of Oklahoma Health Sciences Center, USA.
J Am Soc Echocardiogr. 1996 May-Jun;9(3):337-43. doi: 10.1016/s0894-7317(96)90149-2.
Coronary sinus (CS) diverticula have been reported to be the anatomic basis of some posteroseptal accessory atrioventricular pathways. During 1 year, 53 patients with Wolff-Parkinson-White syndrome referred to our center for catheter ablation were found to have posteroseptal or left posterior accessory pathways. The accessory pathway was associated with an anomaly of the CS in seven patients (13%), including six diverticula of the CS or its branches and one aneurysmal CS. Four of the CS diverticula were visualized by transesophageal echocardiography. Diverticular appear as echolucent, contractile pouches on the epicardial surface of the posteroseptal or posterior left ventricle that connect to the CS by an isthmus. Previous reports have suggested that accessory pathways associated with CS aneurysms have rapid conduction times and may be associated with an increased risk of rapid ventricular response during atrial fibrillation and sudden death; five of our seven patients had a short preexcited R-R interval in the range of 172 to 225 msec during atrial fibrillation. In summary, many, if not the majority, of CS diverticula associated with preexcitation can be visualized by transesophageal echocardiography.
据报道，冠状静脉窦（CS）憩室是一些后间隔房室旁道的解剖学基础。在1年的时间里，我们中心收治了53例因导管消融前来就诊的预激综合征患者，发现他们存在后间隔或左后旁道。在7例（13%）患者中，旁道与CS异常有关，其中包括6例CS或其分支的憩室以及1例CS动脉瘤。4例CS憩室通过经食管超声心动图得以显示。憩室表现为后间隔或左心室后壁心外膜表面的无回声、可收缩的囊袋，通过峡部与CS相连。既往报道提示，与CS动脉瘤相关的旁道传导速度较快，可能与房颤时快速心室反应及猝死风险增加有关；我们的7例患者中有5例在房颤时预激的R-R间期较短，范围在172至225毫秒之间。总之，许多（即便不是大多数）与预激相关的CS憩室可通过经食管超声心动图显示。
