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D Sánchez-Quintana

Publications and source records attributed to D Sánchez-Quintana.

8 recordsLinked to original sources
PubMed2005

Sinus node revisited in the era of electroanatomical mapping and catheter ablation.

OBJECTIVE: To study the architecture of the human sinus node to facilitate understanding of mapping and ablative procedures in its vicinity. METHODS: The sinoatrial region was examined in 47 randomly selected adult human hearts by histological analysis and scanning electron microscopy. RESULTS: The sinus node, crescent-like in shape, and 13.5 (2.5) mm long, was not insulated by a sheath of fibrous tissue. Its margins were irregular, with multiple radiations interdigitating with ordinary atrial myocardium. The distances from the node to endocardium and epicardium were variable. In 72% of the hearts, the whole nodal body was subepicardial and in 13 specimens (28%) the inner aspect of the nodal body was subendocardial. The nodal body cranial to the sinus nodal artery was more subendocardial than the remaining nodal portion, which was separated from the endocardium by the terminal crest. In 50% of hearts, the most caudal boundaries of the body of the node were at least 3.5 mm from the endocardium. When the terminal crest was > 7 mm thick (13 hearts, 28%), the tail was subepicardial or intramyocardial and at least 3 mm from the endocardium. CONCLUSIONS: The length of the node, the absence of an insulating sheath, the presence of nodal radiations, and caudal fragments offer a potential for multiple breakthroughs of the nodal wavefront. The very extensive location of the nodal tissue, the cooling effect of the nodal artery, and the interposing thick terminal crest caudal to this artery have implications for nodal ablation or modification with endocardial catheter techniques.

Adult↗
PubMed2003

[Anatomy of the atria for rhythmologists].

The anatomy of the atria is always in the mind of interventional rhythmologists. There is a mental superposition of the anatomical structures and the references obtained by different incidences of fluoroscopy and the endocavitary electrocardiogram. But understanding the anatomy also requires a certain knowledge of dissection to determine, for example, the orientation of bundles of muscle fibres and anatomical sections. The sino-atrial node is situated at a distance from the endocardium. It is long and protected by its own artery which makes it difficult to reach. The atrio-ventricular node has multiple posterior expansions which correspond to the sites where radiofrequency ablation is effective. The cavo-tricuspid isthmus is the target zone for the treatment of atrial flutter but radiofrequency ablation which must be long may be applied at three different levels: inferolateral, median (the most common site) or inferoseptal. Finally, atrial fibrillation has incited many studies of the muscular extensions of the left atrium to the pulmonary veins, the morphological variations of these veins and the organisation of the muscle fibres of the left atrial wall. They have inspired new concepts of atrial fibrillation.

Arrhythmias, Cardiac↗
PubMed2002

The terminal crest: morphological features relevant to electrophysiology.

OBJECTIVE: To investigate the detailed anatomy of the terminal crest (crista terminalis) and its junctional regions with the pectinate muscles and intercaval area to provide the yardstick for structural normality. DESIGN: 97 human necropsy hearts were studied from patients who were not known to have medical histories of atrial arrhythmias. The dimensions of the terminal crest were measured in width and thickness from epicardium to endocardium, at the four points known to be chosen as sites of ablation. RESULTS: The pectinate muscles originating from the crest and extending along the wall of the appendage towards the vestibule of the tricuspid valve had a non-uniform trabecular pattern in 80% of hearts. Fine structure of the terminal crest studied using light and scanning electron microscopy consisted of much thicker and more numerous fibrous sheaths of endomysium with increasing age of the patient. 36 specimens of 45 (80%) specimens studied by electron microscopy had a predominantly uniform longitudinal arrangement of myocardial fibres within the terminal crest. In contrast, in all specimens, the junctional areas of the terminal crest with the pectinate muscles and with the intercaval area had crossing and non-uniform architecture of myofibres. CONCLUSIONS: The normal anatomy of the muscle fibres and connective tissue in the junctional area of the terminal crest/pectinate muscles and terminal crest/intercaval bundle favours non-uniform anisotropic properties.

Adolescent↗
PubMed2001

Topographic anatomy of the inferior pyramidal space: relevance to radiofrequency catheter ablation.

INTRODUCTION: Radiofrequency catheter ablation carried out in the vicinity of the triangle of Koch risks damaging not only the AV conduction tissues but also their arterial supply. The aim of this study was to examine the relationship of the AV nodal artery to the inferior pyramidal space, the triangle of Koch, and the right atrial endocardial surface. METHODS AND RESULTS: We studied 41 heart specimens, 24 by gross dissections and 17 by histologic sections. The proximity of the AV nodal artery to the surface landmarks of the triangle of Koch was variable, but it was notable that in 75% of specimens the artery passed close to the endocardial surface of the right atrium and within 0.5 to 5 mm of the mouth of the coronary sinus. In all specimens, the mean distance of the artery to the endocardial surface was 3.5 +/- 1.5 mm at the base of Koch's triangle. The location of the compact AV node and its inferior extensions varied within the landmarks of the triangle. At the mid-level of Koch's triangle, the compact node was medially situated in 82% of specimens, but it was closer to the hinge of the tricuspid valve in the remaining 18% of specimens. In 12% of specimens, the inferior parts of the node extended to the level of the mouth of the coronary sinus. CONCLUSION: The nodal artery runs close to the orifice of the coronary sinus, the endocardial surface of the right atrium, the middle cardiac vein, and the specialized conduction tissues in most hearts. The nodal artery and/or the AV conduction tissues can be at risk of damage when ablative procedures are carried out at the base of the triangle of Koch.

Adolescent↗
PubMed2001

Architecture of the pulmonary veins: relevance to radiofrequency ablation.

BACKGROUND: Radiofrequency ablation of tissues in pulmonary veins can eliminate paroxysmal atrial fibrillation. OBJECTIVE: To explore the characteristics of normal pulmonary veins so as to provide more information relevant to radiofrequency ablation. METHODS: 20 structurally normal heart specimens were examined grossly. Histological sections were made from 65 pulmonary veins. RESULTS: The longest myocardial sleeves were found in the superior veins. The sleeves were thickest at the venoatrial junction in the left superior pulmonary veins. For the superior veins, the sleeves were thickest along the inferior walls and thinnest superiorly. The sleeves were composed mainly of circularly or spirally oriented bundles of myocytes with additional bundles that were longitudinally or obliquely oriented, sometimes forming mesh-like arrangements. Fibrotic changes estimated at between 5% and 70% across three transverse sections were seen in 17 veins that were from individuals aged 30 to 72 years. CONCLUSIONS: The myocardial architecture in normal pulmonary veins is highly variable. The complex arrangement, stretch, and increase in fibrosis may produce greater non-uniform anisotropic properties.

Adult↗
PubMed2000

Late ventricular structure after partial left ventriculectomy.

Nine months after partial ventriculectomy, a 53-year-old man died of progressive heart failure. His heart was examined to determine the alignment of the muscle fibers around the ventricular scar, which was 11 cm long, 1.3 cm thick and 4 cm wide. The scar reached 2 to 12 mm beyond the surgical suture line. The fibers in the middle and subendocardial layers were malaligned, resulting in convergence, compression and regional necrosis.

Cardiomyopathy, Alcoholic↗
PubMed1994

Spatial arrangement of the heart muscle fascicles and intramyocardial connective tissue in the Spanish fighting bull (Bos taurus).

The spatial arrangement of the muscle fascicles and intramyocardial connective tissue was examined in the ventricles of the heart of the Spanish fighting bull (Bos taurus). In both ventricles, the muscle fascicles of the myocardium are arranged in 3 main directions, forming 3 muscle layers within the ventricular wall. The preferentially vertical arrangement of the muscle fascicles in the superficial and deep layers at the level of the fibrous aortic rings and the base of the semilunar valve leaflets suggests that these fascicles are actively involved in valvular dynamics. After controlled digestion of myocytes and elastic fibres with NaOH, a 3-dimensional arrangement of the scaffolding of connective tissue that supports the muscle fascicles and myocytes was observed. The arrangement and structure of this scaffolding may influence the order of contraction of muscle fascicles in different layers of the ventricle. In addition, differences were observed between the connective tissue scaffolding surrounding the myocytes of the 2 ventricles; these variations were correlated with the different biomechanical properties.

Animals↗