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Arterial Supply of SAN & AVN Well Characterized With 64-Section Cardiac CT

January 5, 2008
Written by: , Filed in: Cardiac Imaging, Interventional Radiology
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A recent study was conducted to evaluate the coronary arterial supply to the sinuatrial node (SAN) and the atrioventricular node (AVN) using 64-section CT.

Multidetector CT well characterizes the anatomic variation of arterial supply to the sinuatrial and atrioventricular nodes; this information can be potentially used to plan catheter-based or surgical procedures.

Participants
In this retrospective analysis, 102 patients who had a coronary CT angiogram due to suspicion of having coronary artery disease participated.

Methodology
A 64-section multidetector CT was used; 65 mL of intravenous (IV) contrast was administered followed by 50 mL of saline. Oral and/or IV metoprolol was administered as needed to try to achieve a heart rate <65 bpm; sublingual nitroglycerin was also given. Retrospective electrocardiographically-gated volumetric data sets were acquired. Axial sections, with a thickness of 0.5 mm and an increment of 0.3 mm, were analyzed as well as multiplanar reformations created on an off-line workstation. Images were evaluated in consensus by a radiologist and a cardiologist. The anatomy of the sinuatrial nodal artery, the atrioventricular nodal artery, and the first septal perforating artery was characterized. The degree of visualization of these vessels was graded on a 5-point scale, with 1 being "not visualized" to 5 having "excellent visualization." [text_ad] Results
Image quality was considered good in 88.2% of cases, adequate in 6.8% of cases, and poor in 4.9% of cases.

A single sinuatrial nodal artery arose from the proximal 4 cm of the right coronary artery (RCA) in 67 patients (65.7%) and from the proximal 3.5 cm of the left circumflex (LCX) artery in 28 patients (27.4%).

Arterial supply to the SAN via both the RCA and LCX (dual blood supply) was present in 6 cases (5.9%). In 1 patient, the sinuatrial nodal artery was not visualized. The atrioventricular nodal artery arose from the distal RCA in 89 patients (87.2%) and from the distal LCX in 11 patients (10.8%). The AVN was supplied by both the RCA and LCX in 2 patients (2.0%).

Two left and 6 right Kugel anastomotic arteries were seen to supply the area of the AVN. The first septal perforating artery was not seen to connect to the AVN.

Conclusions
64-section CT well characterizes the anatomic variation of coronary vessels supplying both the SAN and AVN.

Reviewer’s Comments
The authors note that characterization of this anatomic variation may be of benefit when planning catheter-based or surgical procedures and depending on the anatomic variation, can alter the procedural approach.

Author: Vineet R. Jain, MD

Reference:
Saremi F, Abolhoda A, et al. Arterial Supply to Sinuatrial and Atrioventricular Nodes: Imaging With Multidetector CT.
Radiology; 2008; 246 (January): 99-107

Cardiac CTA: What You Need to Know
 
 University of California San Francisco, Department of Radiology
 Course Director: Gautham P. Reddy, MD, MPH

 
  Coronary artery disease is the leading cause of morbidity and mortality in industrialized countries. With the advent of 64-detector CT scanners, CT has become an essential tool for evaluation of the heart and great vessels, and is a promising technique for assessment of the coronary arteries.
 
  Click here to read more or order:
  Cardiac CTA: What You Need to Know
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