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Uncommon course of sinus nodal artery: is it a known pathway?/Sinus dugum arterinin sik gorulmeyen seyri: bilinen bir yol mu?

A 69-year-old male, with a prior history of rheumatic valvular disease, presented with dyspnea. Echocardiography revealed severe mitral stenosis with a valve area 0.9 cm2 and severe left atrial dilatation (11 cm). Coronary angiography demonstrated normal coronary arteries but severe mitral stenosis was visualized on cardiac catheterization. Coronary angiography (30[degrees] right anterior oblique, 35[degrees] caudal and 60[degrees] left anterior oblique projections of the left coronary system) demonstrated a rare anatomical variation, in which the sinus node artery had a long course originating from the distal part of the left circumflex artery below or behind the left auricle (Fig. 1; Video 1. See corresponding video/movie images at www.anakarder.com), and coursing in counter-clockwise direction postero-superiorly with a reverse U--shape to the territory of the sinus node (Fig. 2; Video 2A,2B. See corresponding video/movie images atwww.anakarder.com). No other accessory nodal artery was visualized.

The sinus node is usually supplied by the sinoatrial branch via the right coronary artery in 55% of cases and via the left circumflex artery in 45 % of cases.

We describe herein a rare and unusual variation, found in a patient with severe mitral stenosis and left atrial dilatation, in which a posterior sinus node artery originate from the posterior segment of the circumflex artery, coursed postero-superiorly and entered the sinus node from superiorly. Although abnormal course of sinus nodal artery may be an anatomical variation, it could partly be considered that severe dilatation of the left atrium led to abnormal course of posterior sinus node artery.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

Hasan Kocaturk, Mehmet Cengiz Colak, Abdurrezzak Borekci, Ednan Bayram *, Sebahattin Atesal **

Cardiology Service, Sifa Hospital, Erzurum

* Cardiology Service, Numune Hospital, Erzurum

"Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum,Turkey

Address for Correspondence/Yazisma adresi: Dr. Hasan Kocaturk Osman bektas mah. Sekili sok.Osmanlilar apart. A blok 3/5 25070 Erzurum, Turkey Phone: +90.442.329 00 00 Fax: +90.442.329 04 20 E-mail: haskturk@hotmail.com
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Title Annotation:E-page Original Images/E-sayfa Orijinal Goruntuler
Author:Kocaturk, Hasan; Colak, Mehmet Cengiz; Borekci, Abdurrezzak; Bayram, Ednan; Atesal, Sebahattin
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Disease/Disorder overview
Date:Feb 1, 2008
Words:333
Previous Article:Sea star coronary artery/Deniz yildizi koroner arter.
Next Article:Anomalous origin of all three coronary arteries from right aortic sinus/Uc koroner arterin sag aortik sinusten anormal cikisi.
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