Recent developmental findings relevant to the clinical significance of the myocardial venous sleeves

摘要

As DeSimone et al.1 comment when introducing their excellent review of the gross anatomical features of myocar-dial venous sleeves, it was the ground-breaking work of the team from Bordeaux2 that first showed the significance of these myocardial extensions from the atrial walls along the pulmonary veins as potential substrates for atrial fibrillation. Since then, others have pointed to the significance of similar venous sleeves extending along the superior caval vein as another potential substrate,3 while attention has been directed to the morphologic features of the left atrial wall as a guide to those seeking to ablate atrial arrhythmias.4 The team from the Mayo Clinic, led by Asirvatham, has also published several important reviews emphasizing the clinical significance of knowledge of cardiac anatomy, such as the recent overview that appeared in this journal.5 One of us had previously been involved in similar morphologic studies,6 and the studies emanating from Europe have been ably continued by Ho, still collaborating with our Spanish colleagues.4 Examined exclusively from the stance of gross anatomy, however, the current investigation carried out by the group working in Rochester, Minnesota, is paradigmatic. They have studied the morphologic features of the myocardial extensions along the great veins in 620 human hearts. Moreover, they emphasize the potential clinical significance not only of the pulmonary venous sleeves, but also the myocardial extensions along the walls of the superior caval vein, the less frequent extensions onto the termination of the azygos vein, the presence of pectinate muscles in the mouth of the coronary sinus, and the location of the oblique vein of the left atrium, better known to clinicians as the vein of Marshall.1 It is unlikely that any other group will have access to such a large number of human hearts. When considered together with their previous achievements, therefore, their accounts1'5 surely now represent the gold standard for correlations between morphologic observations and clinical electrophysiology.