Echocardiography of the Coronary sinus in Adults
This article is a peer referred and from the Clinical Cardiology Journal. The article is authored by Ivan A. Cruz, Bashar Shala, and Cameila Johns. The article examines how sonography is used in studying coronary sinus (CS) in adults. There are many issues of importance that the authors bring out in the article. The article starts with a brief introduction of coronary sinus (CS) by pointing out the interested of other sub-specialties such as electrophysiologists, anesthesiologists, and generally researchers in CS. However, the authors note that echocardiographers have taken little interest in studying the CS particularly in adult patients. Further, the authors point out that echocardiographic literature in reference to CS has only been with respect to rare congenital cardiovascular abnormalities. These abnormalities are primarily characterized with anomalous drainage of blood into the CS. Such drainage takes place directly or through a persistent left superior vena cava. It is further noted that the drainage result in five condition of which all a dilated CS is experienced. Even more, it is noted that the abnormalities described above are commonly encountered by pediatric cardiologists. This explains why adult echocardiography has rare literature on the condition.
The article also gives an overview on the location of the CS in the heart. Its anatomy and functions are explained in reference to other parts of the heart. After this explanation, the article moves on to discuss the main subject, that is, the dilation of the CS. The article discusses congestive heart failure and show how it causes dilation of the CS. Next, echocardiography of the CS is closely examined. First, the echocardiography of the normal CS is examined. This acts as a reference point for readers to check the differences between a dilated and normal CS. The article gives various phases of images of a normal CS. This is important because in echocardiography, various planes have to be used in utilizing various echocardiographic window opportunities. There are four images presented of a normal CS.
The article also examines, with the help of echocardiographic images of the CS, the dilation of the CS under various abnormalities. Significantly, much interest in dedicated to the abnormalities that involve the left superior vena cava. The article is concluded by examining the Doppler of coronary sinus flow. It is noted that the Doppler recording of CS blood flow presented a challenge for many years and therefore not carried out. The challenge in taking this recording is due to inability to distinguish between the flow in a CS and the inferior caval inflow particularly because both flow in the same direction and more so that the two vessels are close together. The authors of the article were able to overcome this challenge by “measuring the velocity-time integral of CS flow and estimating the CS cross-section in apical 4-chamber view” (153). In this manner, the authors were able to detect “a large increase in CS flow after coronary bypass surgery in 15 patients with coronary artery disease” (153). The authors did great work in their research integrating echocardiographic images with explanation to expand literature available on echocardiography of the CS.
I feel this article has a huge impact on sonography. First, it adds to the significant of sonography as a non-invasive technique of studying internal organs. Further, it focuses on a specific part of the heart and this makes it quite interesting a reading. In fact, it depicts sonography as a technique that enables exactness and precision. This article therefore is of importance to sonography.
I chose this article for this discussion because it focuses on a condition that is given less attention in adult echocardiography. I saw the endeavors of the authors as noble because they tried to study a sub-field that is rarely touched. Further, the authors based undertake a primary research on a number of patients. Therefore, their research is not purely literature based but rather is anchored on a research that was undertaken. Such researches are important in advancing echocardiographic studies. It is through such researches that the field of echocardiography will populate its literature and be better known.
This article presents many lessons. One, observation is important as well as understanding the anatomy of the internal structures. This makes it possible to interpret echocardiographic images well. The article also encourages researchers to delve into studying conditions which may seem to be rare and probably challenging. This makes it possible to present a wholesome healthcare to all patients including those presenting rare conditions. It also, as mentioned above, raises the profile of echocardiography. The research in the article makes my practice more comprehensive. I am now aware on one more way of undertaking a diagnosis if I am presented with the abnormalities discussed in the article. I have no suggestion on how further the article may be improved – I feel it is well presented and discussed.
Cruz, I. A., Shala, M. B., & Johns, C. (2000). Echocardiography of the Coronary Sinus in Adults. Clin. Cardiol. 23: 149-154.