Korean J Radiol.  2012 Oct;13(5):572-578. 10.3348/kjr.2012.13.5.572.

Anatomy of the Sinoatrial Nodal Branch in Korean Population: Imaging with MDCT

• Song YS
• Lee W
• Park EA
• Chung JW
• Park JH

• KMID: 1392935
• DOI: http://doi.org/10.3348/kjr.2012.13.5.572

Abstract

OBJECTIVE
To evaluate, on a retrospective basis, the anatomic characteristics of the arterial supply to the sinoatrial node (SAN) in the Korean population using an ECG-gated multi-detector CT (MDCT).
MATERIALS AND METHODS
The electrocardiographic-gated MDCTs of 500 patients (258 men and 242 women; age range, 17-83 years; mean age, 58.6 +/- 12.04 years) were analyzed retrospectively. In each case, the SAN artery (arteries) was named according to a special nomenclature with regard to origin, course, and termination.
RESULTS
A total of 516 SAN arteries were visualized in 496 patients. The SAN was supplied by a single artery in 476 (96.4%) cases and by 2 arteries in 18 (3.6%) cases. The SAN originated from the right coronary artery in 265 (53.4%) cases and from the left circumflex in 213 (43%) cases.
CONCLUSION
This study can provide basic data on variations of the SAN artery in the Korean population.

Keyword

Sinoatrial node; Sinoatrial nodal artery; SA node; ECG-gated MDCT; Korean population

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
*Cardiac-Gated Imaging Techniques
Coronary Vessel Anomalies/*radiography
Female
Humans
Male
Middle Aged
Republic of Korea
Retrospective Studies
Sinoatrial Node/*radiography
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 R1 subtype SAN artery (white arrow) arising from RCA is seen in axial MIP view. AAo = ascending aorta, LA = left arium, SVC = superior vena cava, SAN = sinoatrial node, RCA = right coronary artery, R1 = medial to the right auricle, MIP = maximum ittensity projection

• 

  Fig. 2 L1 subtype SAN artery (black arrow) arising from LCX is seen in axial MIP view. AAo = ascending aorta, LA = left arium, SVC = superior vena cava, SAN = sinoatrial node, MIP = maximum ittensity projection, LCX = left circumflex

• 

  Fig. 3 MIP images show SAN artery subtypes according to course of terminal segment around SVC. A. Precaval (white arrow). B. Retrocaval (black arrow). C. Pericaval (black arrow). AAo = ascending aorta, LA = left arium, MIP = maximum ittensity projection, SAN = sinoatrial node, SVC = superior vena cava

• 

  Fig. 4 R1m subtype SAN artery (white arrows) arising from middle segment of RCA (black arrow). AAo = ascending aorta, LA = left arium, SAN = sinoatrial node, SVC = superior vena cava, RCA = right coronary artery, R1m = originated from middle segment of right coronary artery and run medial to right auricle

• 

  Fig. 5 S-shaped SAN artery (black and white arrows) arising from LCX and running between left superior pulmonary vein and left atrial auricular is seen in MIP images (A, B). AAo = ascending aorta, SAN = sinoatrial node, SVC = superior vena cava, LAA = left atrial appendage, LCX = left circumflex, LSPV = left superior pulmonary vein, MIP = maximum ittensity projection

Reference

1. Ando' G, Gaspardone A, Proietti I. Acute thrombosis of the sinus node artery: arrhythmological implications. Heart. 2003. 89:E5.

2. de Groot NM, Schalij MJ. The relationship between sinus node dysfunction, bradycardia-mediated atrial remodelling, and post-operative atrial flutter in patients with congenital heart defects. Eur Heart J. 2006. 27:2036–2037.

3. Angelini P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J. 1989. 117:418–434.

4. Baltaxe HA, Wixson D. The incidence of congenital anomalies of the coronary arteries in the adult population. Radiology. 1977. 122:47–52.

5. Datta J, White CS, Gilkeson RC, Meyer CA, Kansal S, Jani ML, et al. Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography. Radiology. 2005. 235:812–818.

6. Campbell JS. Stereoscopic radiography of the coronary system. Quart J Med. 1929. 22:247–268.

7. Vieweg WV, Alpert JS, Hagan AD. Origin of the sinoatrial node and atrioventricular node arteries in right, mixed, and left inferior emphasis systems. Cathet Cardiovasc Diagn. 1975. 1:361–373.

8. Okmen AS, Okmen E. Sinoatrial node artery arising from posterolateral branch of right coronary artery: definition by screening consecutive 1500 coronary angiographies. Anadolu Kardiyol Derg. 2009. 9:481–485.

9. James TN. Anatomy of the human sinus node. Anat Rec. 1961. 141:109–139.

10. Romhilt DW, Hackel DB, Estes EH Jr. Origin of blood supply to sinoauricular and atrioventricular node. Am Heart J. 1968. 75:279–280.

11. Bokeriya LA, Mikhailin SI, Revishvili AS. Anatomical variants of sinoatrial and atrioventricular node arteries. Cor Vasa. 1984. 26:220–228.

12. Busquet J, Fontan F, Anderson RH, Ho SY, Davies MJ. The surgical significance of the atrial branches of the coronary arteries. Int J Cardiol. 1984. 6:223–236.

13. Caetano AG, Lopes AC, DiDio LJ, Prates JC. [Critical analysis of the clinical and surgical importance of the variations in the origin of the sinoatrial node artery of the human heart]. Rev Assoc Med Bras. 1995. 41:94–102.

14. Sow ML, Ndoye JM, Lô EA. The artery of the sinuatrial node: anatomic considerations based on 45 injection-dissections of the heart. Surg Radiol Anat. 1996. 18:103–109.

15. Futami C, Tanuma K, Tanuma Y, Saito T. The arterial blood supply of the conducting system in normal human hearts. Surg Radiol Anat. 2003. 25:42–49.

16. Kawashima T, Sasaki H. The morphological significance of the human sinuatrial nodal branch (artery). Heart Vessels. 2003. 18:213–219.

17. Ortale JR, Paganoti Cde F, Marchiori GF. Anatomical variations in the human sinuatrial nodal artery. Clinics (Sao Paulo). 2006. 61:551–558.

18. Hadziselimović H. Vascularization of the conducting system in the human heart. Acta Anat (Basel). 1978. 102:105–110.

19. Park BJ, Sung DJ, Kim MJ, Cho SB, Kim YH, Chung KB, et al. The incidence and anatomy of accessory pudendal arteries as depicted on multidetector-row CT angiography: clinical implications of preoperative evaluation for laparoscopic and robot-assisted radical prostatectomy. Korean J Radiol. 2009. 10:587–595.

20. Kumar S, Neyaz Z, Gupta A. The utility of 64 channel multidetector CT angiography for evaluating the renal vascular anatomy and possible variations: a pictorial essay. Korean J Radiol. 2010. 11:346–354.

21. Saremi F, Abolhoda A, Ashikyan O, Milliken JC, Narula J, Gurudevan SV, et al. Arterial supply to sinuatrial and atrioventricular nodes: imaging with multidetector CT. Radiology. 2008. 246:99–107. discussion 108-109.

22. Saremi F, Channual S, Abolhoda A, Gurudevan SV, Narula J, Milliken JC. MDCT of the S-shaped sinoatrial node artery. AJR Am J Roentgenol. 2008. 190:1569–1575.

23. Ozturk E, Saglam M, Bozlar U, Kemal Sivrioglu A, Karaman B, Onat L, et al. Arterial supply of the sinoatrial node: a CT coronary angiographic study. Int J Cardiovasc Imaging. 2011. 27:619–627.

24. Zhang LJ, Wang YZ, Huang W, Chen P, Zhou CS, Lu GM. Anatomical investigation of the sinus node artery using dual-source computed tomography. Circ J. 2008. 72:1615–1620.

25. Buss DD, Hyde DM, Steffey EP. Coronary collateral development in the rhesus monkey (Macaca mulatta). Basic Res Cardiol. 1983. 78:510–517.

26. Petronio AS, Baglini R, Limbruno U, Mengozzi G, Amoroso G, Cantarelli A, et al. Coronary collateral circulation behaviour and myocardial viability in chronic total occlusion treated with coronary angioplasty. Eur Heart J. 1998. 19:1681–1687.

27. Lee CM, Leung TK, Wang HJ, Lee WH, Shen LK, Chen YY. Identification of a coronary-to-bronchial-artery communication with MDCT shows the diagnostic potential of this new technology: case report and review. J Thorac Imaging. 2007. 22:274–276.

28. Peynircioglu B, Ergun O, Hazirolan T, Cil BE, Aytemir K. Bronchial to coronary artery fistulas: an important sign of silent coronary artery disease and potential complication during bronchial artery embolization. Acta Radiol. 2007. 48:171–172.

29. Gaudino M, Alessandrini F, Glieca F, Martinelli L, Santarelli P, Bruno P, et al. Conventional left atrial versus superior septal approach for mitral valve replacement. Ann Thorac Surg. 1997. 63:1123–1127.

30. Misawa Y, Fuse K, Kawahito K, Saito T, Konishi H. Conduction disturbances after superior septal approach for mitral valve repair. Ann Thorac Surg. 1999. 68:1262–1264. discussion 1264-1265.

31. Lanciego C, Rodriguez M, Rodriguez A, Carbonell MA, García LG. Permanent pacemaker-induced superior vena cava syndrome: successful treatment by endovascular stent. Cardiovasc Intervent Radiol. 2003. 26:576–579.

32. Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol. 2005. 46:552–557.