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04 - Arteries NOT called (Veins or Thebesian)

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    • 1957 posts
    May 20, 2014 9:51:50 AM PDT

     

     

    One of the most insightful articles regarding the vessels_of_Wearn, is that of Muir, CS. Muir's sections are arguably among the best because the heart has been sectioned and displayed in a manner that permits viewing the length of the lumen of the pathologically altered vessel_of_Wearn.

     

    The clinically "fistulous," vessel of Wearn's lumen is visible in a single plane. Most cases the sections of the heart are not near-parallel with the long-axis of the fistula's lumen, and therefore only part of the "vessels of Wearn," is appreciable without three-dimensional reconstruction,which can be facilitated by serial histologic sections. 

     

    Muir, CS from Singapore at the University of Malaya, published in the British Jou

     

     http://www.ncbi.nlm.nih.gov/pubmed/14425053

     

     

    Br Heart J. Jun 1960; 22(3): 374–384. PMCID: PMC1017668 CORONARY ARTERIO-CAMERAL FISTULA C. S. Muir Department of Pathology, University of Malaya in Singapore

     vessel_of_Wearn 1960 Br Heart J

     

    Cardioplegia, one liter of crystalloid solution injected over three minutes at a pressure of of 60-to-80 mmHg  through the right atrium results in effluent obtained in the aortic root. Presumably this occurs through the vessels of wearn.1

    Right atrium  -> vessels of wearn -> coronary arteries -> aortic root

     

    Rigth atrium  -> right ventricle -> vessels of wearn -> coronary arteries -> aortic root

     

    1.            Fabiani JN, Deloche A, Swanson J, Carpentier A. Retrograde cardioplegia through the right atrium. The Annals of thoracic surgery 1986;41:101-2.

     

    Cardioplegia RA to Wearn to Aorta


    This post was edited by Brett Snodgrass at February 5, 2015 5:29:57 AM PST
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    • 1957 posts
    May 27, 2014 7:28:07 PM PDT
     
    "Anastomotic coronary vessels in hypoplasia of the right ventricle"
    M J Finegold, K M Klein, Am. Heart J., 82 (1971)
    Comments (1):
     
    Comment from PubMed Commons:
     ( May 27th, 2014 12:50am UTC )
    Brett Snodgrass | Jan 08 2014 14:09 EST
    Thank you for the excellent article.

    The authors write “intramyocardial channels normally joining the coronary arteries to the ventricular chambers.” Wearn described these ventriculocoronary arterial connections in addition to atriocoronary arterial connections. The eponym and only pronoun applied to these connections is the vessels of Wearn.

    http://bit.ly/JTWearn

    Finegold et al. astutely acknowledged the vessels of Wearn (connections) as a possible etiology for their findings. For further information related to PAIVS and the connections, please see:

    http://www.ncbi.nlm.nih.gov/pubmed/23332812https://twitter.com/BrettSnodgrass1/status/419317173689909248

    Comments or suggestions are welcome.

    Thank you kindly.


    http://www.ncbi.nlm.nih.gov/pubmed/5115819#cm5115819_1990
     
    https://pubpeer.com/publications/F22533CB2FC0BB4EB88C5655A12F3B

    This post was edited by Brett Snodgrass at May 27, 2014 7:31:32 PM PDT
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    May 27, 2014 7:33:35 PM PDT
    "Diffuse coronary artery to left ventricular communications: an unusual cause of demonstrable ischemia"
    F Duckworth, J Mukharji, G W Vetrovec, Cathet Cardiovasc Diagn, 13 (1987 Mar-Apr)
    Comments (1):

     

     

    Brett Snodgrass | Jan 07 2014 22:45 EST
    Dear Reader,

    These diffuse (minute, aka fine) connections may be consistent with the vessels of Wearn. Since we cannot definitively exclude an arteriosinusoidal vessel, using the term "vessels of Wearn" is appropriate.

    It is also possible that some of the connections enter the capillary bed before entering the heart chamber. If that is the case, then it is possible that some of the connections are Thebesian connections.

    For serial histologic sections, Wearn studied the arteriosinusoidal and arterioluminal vessels utilizing cold celloidin that was too thick to enter the capillaries. Wearn did note that when India ink was injected into the coronary arteries it would enter the heart chambers through numerous minute connections. Since, the ink would not permit serial histologic sections with 3D reconstruction as was used for the arteriosinusoidal and arterioluminal vessels, we may not have sufficient information to specify whether the connections are Arterio-capillary-cameral, or Arterio-capillary-venule-cameral (The venule-cameral connection would be a Thebesian vein).

    Thus, when the diffuse connections are identified, we do not have sufficient data to determine whether they are arteriosinusoidal only, or whether some are arteriosinusoidal and some enter the capillary bed before entering the heart chamber. In addition, if some of the connections were arterioluminal vessels, then we would have an even more difficult time naming the radiographic finding. Thus, the term vessel of Wearn has been proposed. For additional commentary, please see. https://twitter.com/BrettSnodgrass1/status/404825015771619328 and https://twitter.com/BrettSnodgrass1/status/413860163033247744

    Comments, disagreements, and suggestions are welcome.

    Thank you kindly.


    http://www.ncbi.nlm.nih.gov/pubmed/3581166#cm3581166_1915

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    June 4, 2014 4:40:59 PM PDT

    http://circres.ahajournals.org/lookup/resid/94/3/346?view=full&uritype=cgi

     

    Always be cautious in reading an article, after corresponding with one of the authors on this excellent study, what I found out is that they did not identify the "vessels of Wearn," with great frequency. However, they did identify the #vessels_of_Wearn in the right ventricular outflow tract in this study. 

     

    This is further corroborating data that these "fistula," are often normal.


    This post was edited by Brett Snodgrass at June 4, 2014 4:55:45 PM PDT
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    June 8, 2014 3:28:57 AM PDT

    Arteriosinusoidal artery connecting myocardial sinusoid 

    • R.T. Grant
    • An unusual anomaly of the coronary vessels in the malformed heart of a child

    • Heart, 13 (1926), pp. 273–284


    This post was edited by Brett Snodgrass at June 8, 2014 3:33:43 AM PDT
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    June 8, 2014 3:40:41 AM PDT

    Serial sections of the above image show that the dilated sinusoid (presumably a pathologically altered sinusoid and not an arterioluminal vessel. 

    secondary fibromuscular dysplasia PAIVS

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    June 8, 2014 3:45:34 AM PDT

    Here is a tangential section of myocardial sinusoid. The pediatric Cardiologist identified flow between the heart chamber and the coronary arteries. Furthermore, the report didn't call them thebesian veins. Perhaps a sign that we had a great team to write up this case. It really should be simple, but the number of very confused publications is large. With the internet, and all of the literature now uploaded, it would be prudent for us to collaborate and make that which is simple, both simple and accurate. 

     

    vessels of Wearn PAIVS RVDCC coronary