Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist

A study of 603 hearts

Apoor S. Gami, Amit Noheria, Nirusha Lachman, William D. Edwards, Paul Andrew Friedman, Deepak Talreja, Stephen C. Hammill, Thomas M. Munger, Douglas L Packer, Samuel J Asirvatham

Research output: Contribution to journalArticle

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Abstract

Introduction: Certain outflow tract tachyarrhythmias require ablation above the semilunar valves. Understanding of the regional anatomy of these arrhythmogenic sites is required to avoid complications. Methods and results: We examined 603 formalin-fixed autopsy hearts from October 1998 to July 2003. Three hundred forty-two of 603 (57%) had myocardial extensions above the aortic valve, and 446 of 602 (74%) had extensions above the pulmonary valve. Extensions were noted above the aortic right coronary cusp (RCC) in 332 of 603 (55%; 2.8 ± 1.2 mm), left coronary cusp (LCC) in 145 of 603 (24%; 1.5 ± 0.5 mm), and non-coronary/posterior cusp in four of 603 (0.66%; 1.3 ± 0.5 mm; p < 0.0001), intercuspally in 295 of 603 (49%; 2.2 ± 1.1 mm) and into the cusps in 13 of 603 (2.2%). Extensions were noted above the pulmonary right cusp in 360 of 602 (60%; 4.0 ± 2.5 mm), posterior/left cusp in 313 of 602 (52%; 3.6 ± 2.1 mm), and anterior cusp in 268 of 602 (45%; 3.7 ± 2.2 mm; p < 0.0001), intercuspally in 438 of 602 (73%; 3.4 ± 1.8 mm) and into the cusps in ten of 602 (1.7%). The left main coronary artery was closer to the myocardial extensions above the nearest pulmonary valve cusp (posterior) than those above the nearest aortic valve cusp (LCC; 4.8 ± 1.7 vs. 16.3 ± 3.3 mm, p = 0.0005). Conclusion: Myocardial extensions are common into the great arteries above the semilunar cusps and intercuspally, and rarely into the cusps themselves. The extensions are larger and more symmetric above the pulmonary cusps as compared to the aortic cusps, the most prominent aortic extensions being above the RCC. The left main coronary artery courses close to the extensions above the posterior pulmonary cusp.

Original languageEnglish (US)
Pages (from-to)5-15
Number of pages11
JournalJournal of Interventional Cardiac Electrophysiology
Volume30
Issue number1
DOIs
StatePublished - Jan 2011

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Heart Valves
Pulmonary Valve
Aortic Valve
Lung
Coronary Vessels
Regional Anatomy
Tachycardia
Formaldehyde
Autopsy
Arteries

Keywords

  • Aortic cusps
  • Aortic valve
  • Cardiac anatomy
  • Coronary arteries
  • Electrophysiology
  • Pulmonary valve
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist : A study of 603 hearts. / Gami, Apoor S.; Noheria, Amit; Lachman, Nirusha; Edwards, William D.; Friedman, Paul Andrew; Talreja, Deepak; Hammill, Stephen C.; Munger, Thomas M.; Packer, Douglas L; Asirvatham, Samuel J.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 30, No. 1, 01.2011, p. 5-15.

Research output: Contribution to journalArticle

Gami, Apoor S. ; Noheria, Amit ; Lachman, Nirusha ; Edwards, William D. ; Friedman, Paul Andrew ; Talreja, Deepak ; Hammill, Stephen C. ; Munger, Thomas M. ; Packer, Douglas L ; Asirvatham, Samuel J. / Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist : A study of 603 hearts. In: Journal of Interventional Cardiac Electrophysiology. 2011 ; Vol. 30, No. 1. pp. 5-15.
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abstract = "Introduction: Certain outflow tract tachyarrhythmias require ablation above the semilunar valves. Understanding of the regional anatomy of these arrhythmogenic sites is required to avoid complications. Methods and results: We examined 603 formalin-fixed autopsy hearts from October 1998 to July 2003. Three hundred forty-two of 603 (57{\%}) had myocardial extensions above the aortic valve, and 446 of 602 (74{\%}) had extensions above the pulmonary valve. Extensions were noted above the aortic right coronary cusp (RCC) in 332 of 603 (55{\%}; 2.8 ± 1.2 mm), left coronary cusp (LCC) in 145 of 603 (24{\%}; 1.5 ± 0.5 mm), and non-coronary/posterior cusp in four of 603 (0.66{\%}; 1.3 ± 0.5 mm; p < 0.0001), intercuspally in 295 of 603 (49{\%}; 2.2 ± 1.1 mm) and into the cusps in 13 of 603 (2.2{\%}). Extensions were noted above the pulmonary right cusp in 360 of 602 (60{\%}; 4.0 ± 2.5 mm), posterior/left cusp in 313 of 602 (52{\%}; 3.6 ± 2.1 mm), and anterior cusp in 268 of 602 (45{\%}; 3.7 ± 2.2 mm; p < 0.0001), intercuspally in 438 of 602 (73{\%}; 3.4 ± 1.8 mm) and into the cusps in ten of 602 (1.7{\%}). The left main coronary artery was closer to the myocardial extensions above the nearest pulmonary valve cusp (posterior) than those above the nearest aortic valve cusp (LCC; 4.8 ± 1.7 vs. 16.3 ± 3.3 mm, p = 0.0005). Conclusion: Myocardial extensions are common into the great arteries above the semilunar cusps and intercuspally, and rarely into the cusps themselves. The extensions are larger and more symmetric above the pulmonary cusps as compared to the aortic cusps, the most prominent aortic extensions being above the RCC. The left main coronary artery courses close to the extensions above the posterior pulmonary cusp.",
keywords = "Aortic cusps, Aortic valve, Cardiac anatomy, Coronary arteries, Electrophysiology, Pulmonary valve, Radiofrequency ablation",
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T1 - Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist

T2 - A study of 603 hearts

AU - Gami, Apoor S.

AU - Noheria, Amit

AU - Lachman, Nirusha

AU - Edwards, William D.

AU - Friedman, Paul Andrew

AU - Talreja, Deepak

AU - Hammill, Stephen C.

AU - Munger, Thomas M.

AU - Packer, Douglas L

AU - Asirvatham, Samuel J

PY - 2011/1

Y1 - 2011/1

N2 - Introduction: Certain outflow tract tachyarrhythmias require ablation above the semilunar valves. Understanding of the regional anatomy of these arrhythmogenic sites is required to avoid complications. Methods and results: We examined 603 formalin-fixed autopsy hearts from October 1998 to July 2003. Three hundred forty-two of 603 (57%) had myocardial extensions above the aortic valve, and 446 of 602 (74%) had extensions above the pulmonary valve. Extensions were noted above the aortic right coronary cusp (RCC) in 332 of 603 (55%; 2.8 ± 1.2 mm), left coronary cusp (LCC) in 145 of 603 (24%; 1.5 ± 0.5 mm), and non-coronary/posterior cusp in four of 603 (0.66%; 1.3 ± 0.5 mm; p < 0.0001), intercuspally in 295 of 603 (49%; 2.2 ± 1.1 mm) and into the cusps in 13 of 603 (2.2%). Extensions were noted above the pulmonary right cusp in 360 of 602 (60%; 4.0 ± 2.5 mm), posterior/left cusp in 313 of 602 (52%; 3.6 ± 2.1 mm), and anterior cusp in 268 of 602 (45%; 3.7 ± 2.2 mm; p < 0.0001), intercuspally in 438 of 602 (73%; 3.4 ± 1.8 mm) and into the cusps in ten of 602 (1.7%). The left main coronary artery was closer to the myocardial extensions above the nearest pulmonary valve cusp (posterior) than those above the nearest aortic valve cusp (LCC; 4.8 ± 1.7 vs. 16.3 ± 3.3 mm, p = 0.0005). Conclusion: Myocardial extensions are common into the great arteries above the semilunar cusps and intercuspally, and rarely into the cusps themselves. The extensions are larger and more symmetric above the pulmonary cusps as compared to the aortic cusps, the most prominent aortic extensions being above the RCC. The left main coronary artery courses close to the extensions above the posterior pulmonary cusp.

AB - Introduction: Certain outflow tract tachyarrhythmias require ablation above the semilunar valves. Understanding of the regional anatomy of these arrhythmogenic sites is required to avoid complications. Methods and results: We examined 603 formalin-fixed autopsy hearts from October 1998 to July 2003. Three hundred forty-two of 603 (57%) had myocardial extensions above the aortic valve, and 446 of 602 (74%) had extensions above the pulmonary valve. Extensions were noted above the aortic right coronary cusp (RCC) in 332 of 603 (55%; 2.8 ± 1.2 mm), left coronary cusp (LCC) in 145 of 603 (24%; 1.5 ± 0.5 mm), and non-coronary/posterior cusp in four of 603 (0.66%; 1.3 ± 0.5 mm; p < 0.0001), intercuspally in 295 of 603 (49%; 2.2 ± 1.1 mm) and into the cusps in 13 of 603 (2.2%). Extensions were noted above the pulmonary right cusp in 360 of 602 (60%; 4.0 ± 2.5 mm), posterior/left cusp in 313 of 602 (52%; 3.6 ± 2.1 mm), and anterior cusp in 268 of 602 (45%; 3.7 ± 2.2 mm; p < 0.0001), intercuspally in 438 of 602 (73%; 3.4 ± 1.8 mm) and into the cusps in ten of 602 (1.7%). The left main coronary artery was closer to the myocardial extensions above the nearest pulmonary valve cusp (posterior) than those above the nearest aortic valve cusp (LCC; 4.8 ± 1.7 vs. 16.3 ± 3.3 mm, p = 0.0005). Conclusion: Myocardial extensions are common into the great arteries above the semilunar cusps and intercuspally, and rarely into the cusps themselves. The extensions are larger and more symmetric above the pulmonary cusps as compared to the aortic cusps, the most prominent aortic extensions being above the RCC. The left main coronary artery courses close to the extensions above the posterior pulmonary cusp.

KW - Aortic cusps

KW - Aortic valve

KW - Cardiac anatomy

KW - Coronary arteries

KW - Electrophysiology

KW - Pulmonary valve

KW - Radiofrequency ablation

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